End of Life
I recommend that you have in place the documents mentioned
below (and also have Wills and other financial planning documents set
up by a lawyer who handles estates).
Be sure to scroll down to the end of
this page for some relevant links as well as a CME paper on making the
transition to hospice in CA A Cancer J for Clinicians.
Included in this paper are the Karnofsky and ECOG Performance
Status Scales and the Palliative Performance Scale (table 3).
Advance Directives -
by state One way to communicate
your wishes about future health care decisions is through "advance
directives," which are legal documents that allow you to convey your
decisions about your health care, especially end-of-life care.
Read the column written by Carolyn
M. Clancy, M.D. (dated July 7, 2009) on
End-of-Life Treatment Decisions
Long before you need care, you
need to think and talk about the kind of care you want in the event
of a stroke, terminal illness or life-threatening event occurs.
In addition to talking with
your family members, talk to your doctor about your wishes. AHRQ
research found that only 12% of patients with advance directive had
received input from their doctor. Lack of communication with
doctors causes confusion about medical treatments, conditions, and
choices that need to be made.
Dr. Clancy indicated that AHRQ-funded studies show that
conversations with doctors about advance care planning led to increased
satisfaction among patients age 65 years and older. Patients who talked
with their families or physicians about their preferences for
Had less fear and anxiety.
Felt they had more ability to
influence and direct their medical care.
Believed that their physicians
had a better understanding of their wishes.
Indicated a greater understanding
and comfort level than they had before the discussion.
Types of advance directives worth
living will, which is a formal
legal document, authorized by State laws, that describes the kinds of
medical treatments you want or do not want if you become incapacitated.
It can be as specific or general as you wish.
A durable power of attorney, also
known as a health care proxy, which is a document that lets you
designate a person to make treatment decisions for you if you cannot
make those decisions. You'll want to alert your proxy that you have
given him or her this responsibility and talk about your wishes.
Do-Not-Resuscitate (DNR) order,
which is a document that directs what measures should or should not be
taken on your behalf in events such as cardiac or respiratory arrest.
Typically, a DNR order is directed to emergency medical services or
other first responders.
Patient Comments and Actions
Excellent advice. I am not an attorney, but I have been the executor
for 5 different relatives in 3 states and can state that proper planning
and documentation saves the survivor(s) many times the expense and
effort that it takes to put everything in place. Things go much
smoother and more quickly when everything is in place ahead of time.
Also, the lack of proper wills and powers can result in final care not
being done as we wish, or estates going to relatives we didnt intend,
or even to taxes.
Best Wishes to All.
We keep putting it off and really need to get off our butts and do it.
I think subconsciously I keep putting it off because it seems so final,
or almost admitting that at some point there will be an end. I sent an
email to an attorney last night after your 'prompting'! We'll meet with
him next week.
My wife and I finally got around to doing this after having postponed it
for too long.) I think the brain mets probably scared us into
finally doing it. A lawyer made it easy.
Dr. Clancy's article
lists the following more information
Agency for Healthcare
Research and Quality
Advance Care Planning: Preferences
for Care at the End of Life
American Bar Association's
Commission on Law & Aging
Consumer's Tool Kit for Health Care
Aging with Dignity
National Hospice and
Palliative Care Organization
Advance Directives: Planning for the
Talking About Your Final Wishes
National Long Term Care
Ombudsman Resource Center
Current as of July
Citation for Dr. Clancy's article.
End-of-life Treatment Decisions.
Navigating the Health Care System:
Advice Columns from Dr. Carolyn Clancy,
July 7, 2009. Agency for Healthcare
Research and Quality, Rockville, MD.
Cure Magazine (Curetoday.com)
published an article related to end of
life in the Spring 2009 issue. Read
"The Final Journey"
Finlay, D Casarett,
Making Difficult Discussions Easier:
Using Prognosis to Facilitate
Transitions to Hospice, CA A Cancer
Journal for Clinicians, Vol 59, Number
4, July/August 2009.
Author: Howard Hansen, created 7/18/2009