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No reason for controversy over end-of-life planning

Consumer Reports News: January 11, 2011 11:38 AM

For doctors like me, and anyone who has been at the bedside of a dying person, end-of-life planning can make at least some order out of chaos. And such planning appears to be gaining acceptance, according to a report issued this month by the Centers for Disease Control and Prevention. It found that nearly two-thirds of nursing home patients, 28 percent of home health-care patients, and 5 to 15 percent of healthy adults now have living wills or other advanced directives.

That’s why I’m perplexed by all the controversy over President Obama’s attempts to make end-of-life planning part of routine patient care. After much back and forth, last week the administration again decided to back away from the measure, presumably to avoid an outcry from the same people who had previously claimed, wrongly, that it would somehow amount to government run “death panels” that decide who among the very ill gets to live.

I learned my lesson long ago as a young internist called to the emergency room to see the 85-year-old father of a patient of mine, who had traveled from Florida to visit his daughter.  He had developed pneumonia with high fever and was now semi-comatose. He was legally blind from long-standing diabetes, on dialysis for end-stage kidney disease, and had lung cancer that had spread to his bones and brain. His memory had failed, too, so he no longer recognized his daughter.

Because there was no living will, I asked the daughter whether she would consent to withhold treatment because of the terminal cancer and other health problems and, if his heart failed, if she wanted her father resuscitated. The daughter said she needed to talk with her brother, who hadn’t seen his father in ten years. “They never got along,” she admitted. Reached by phone, the brother insisted that “everything possible” be done. So I started the patient on antibiotics. Three days later the cardiac-arrest team intervened to stop a potentially fatal heart rhythm. A week later, a similar intervention failed—a conclusion to a ten-day nightmare I will never forget and one that, unfortunately, is still repeated every day in hospitals across the country.

The time to execute a living will is when you’re well, not when you’re faced with the prospect of dying or are unable to make decisions for yourself. Age makes no difference. Accidents are a major cause of death at any age, and in some cases, brain injury can preclude any decision-making capability.

If your doctor doesn’t bring up the subject, you should, at your next regular check up. Since no living will can cover all possibilities, you should also designate a trusted someone who shares your end-of-life philosophy as your health-care proxy. All that is needed is your signature, a witness or two, and the signature of a notary. No legal expertise is needed. For examples of forms you can complete yourself, go to CaringInfo.org, Nolo.com, or LivingWillRegistry.com. Give copies to your physician, lawyer, and appropriate family members. And don’t forget to update the document and proxy every three years or so.

Marvin M. Lipman, M.D., Consumer Reports’ chief medical adviser

Have you had an experience with end-of-life planning? Share your story (it could help someone else).

 

 

 

 

 

 


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