Friday, October 2, 2009

End of Life Medicine - Know What You Want

In the United States we pride ourselves on our medical advancements.  We love how many ways we have learned to save lives, and we enjoy stories of heroic measures bringing people back from the brink of death.  Our medical system is geared towards saving lives, not losing them. (As it should be.)

What we are not good at is letting go.  As a society we don't like to talk about death unless it is on the news with a heart wrenching story behind it.  Death in the US may be talked about by newscasters for headlines, however, it is not talked about within our families.

Very few people discuss their end of life preferences.  Now before you get uncomfortable and stop reading I want you to think about it.  How many people in your life right now do you know their final wishes?  How many of those people do you just assume would want what you want? Do they want every test and treatment they can have to prolong their lives, or do they want to back off and die naturally? Do they want heroic measures or not?  Do they prefer to be in a hospital or at home?  Do they want a funeral or a simple graveside memorial?

Knowing the answers to those questions is important.  Knowing those answers for yourself is also important.  Writing everything down is imperative.  There are far too many stories where a living will is ignored because the family doesn't know about it, or it wasn't explained to them and they force the doctor to prolong life. 

I had the chance to read an article in Newsweek lately regarding the costs of medical treatment in the United States.  I found it interesting that they talked specifically about the costs associated with dying.  Data shows that a full one third of Medicare's annual expenses go to treating terminally ill patients in the last 2 years of life.  That number is over 66 billion dollars annually.  While it may seem overwhelmingly obvious that we spend money to treat sick people, and people who are dying are sick, therefore, we spend money on them, there is more to it than that.  As a society we don't like the thought of dying.  We really don't like the thought of our loved ones dying.  We will do anything to stop or at least hold off the process until the very last moment.

So here is the action item for you.  Figure out what you want.  Decide now how you want to go if you have the choice.  Do you want heroic measures?  Do you want life support?  Do you want to be in a hospital?  Do you want Hospice? Do you want to be at home? Figure it out.

You may want to schedule time with your doctor and/or religious leader to talk about your decisions.  Research is showing that having those conversations and documenting a plan is increasing the quality of end of life and significantly reducing medical expenses.

When you have thought through your wishes document them.  Many states have statutory forms to sign and have witnessed.  Take the time to fill these forms out. Then share them with your family.  If you are very ill and unable to make decisions on your own they will be called upon to enforce your plan. If they are included things will go a lot smoother.

Make sure you put the appropriate paperwork where the family can find it.  Prepared Binder - Home Edition is a great place for that.  You can look at our website for links to state's statutory legal forms and other important information such as the federal funeral rule.  Use the forms in Prepared Binder - Home Edition to start important conversations with your family.  It truly is your life, and your death.  Have a plan, and be prepared.

If you would like to read the Newsweek article, click here.

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