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Creating an End-of-life Plan Can Help Avoid Unwanted Complications

Central Washington Senior Times

Preparing the documents that deal with health care and legal matters pertaining to end-of- life issues is not a job that people look forward to. It is a moment when one considers one’s own mortality and that can be difficult for many to anticipate. “Most Americans haven’t taken steps to fill out a living will or designate a health-care proxy,” Said Sen. Bill Nelson chairman of the Senate Special Committee on Aging. Added Sen. Susan Collins, ranking member of the same committee, while most people believe advance care planning is important, “only about a third of the adult population has completed an advance directive.” And even then an advance directive or AD may not be sufficient. A classic case in point is a gentleman whose case was recounted to a Senate Aging Committee hearing by Amy Vandenbrocke, executive director of the National Physician Orders for Life-Sustaining Treatment Paradigm Task Force. Max, then 75 years of age, was a man who loved nature and had a high respect for developments in technology. He did not want to become encased in machines and tubes to preserve his life. He prepared an advance directive to indicate how he wanted to be cared for and named someone to speak for him in case he was unable to state his health-care wishes. As Medicare defines and advance directive, there are three elements: a health-care proxy or a durable power of attorney, a living will, and information on organ or tissue donation. It also suggests that all of this be talked over by family and friends to ensure that everyone is familiar with the contents of these documents. There is another caveat involved. Advance directives are not sufficient in and of themselves to ensure that one’s health-care will be delivered in the manner desired. There now is a new document for this purpose, known by the long name, Physicians Orders for Life- Sustaining Treatment, or its acronym, POLST.

As Vanderbroucke said this “is not for everyone: only patients with serious advanced illnesses should have a POLST form.” What are the major differences between the two?

Again Vandernbroucke outlines how they compare. The POLST form is a medical order, while the advance directive is a legal form. The former states specific medical treatments, while the latter describes general treatment. POLST is for those with an advanced illness, while the AD is for anyone over 18.

A POLST can be changed at any time, whereas an AD requires legal counsel. The POLST is signed by a health care professional as determined by state law and the AD is signed by an individual or health-care representative again according to state law.

Max had made it very clear to his family that he did not want to be kept alive by artificial means and his family understood and was supportive of his decision. Max had a heart condition, with one of the valves beginning to close, but, despite this, he stuck by his initial decision and continued his activities. Five years later, he collapsed while playing golf. Although his wife had an advance directive, it did no good. The emergency personnel had to keep trying to revive him. “In a medical emergency, EMT’s have no choice but to do everything possible to save a life unless they have medical orders to the contrary,” said Vandenbroucke. The advance directive was not even looked at until he reached the hospital where he died. Behind this decision to have control over one’s life, is the additional blessing that it offers, as H. James Towney, founder of Aging with Dignity, noted: “Our healthcare system has turned dying into a medical moment, and has made many who are ill feel powerless, as those they are objects on some health care conveyor belt. Dying in America is too often characterized by poor pain management, loneliness, and spiritual starvation.” His organization, started with Eunice Kennedy Shriver, supports the Five Wishes for those who are reaching the end of their lives. As he further pointed out to the Senate Committee, no one document can cover all the possibilities of health care when a patient is in a critical stage of health care, there are still “gray areas” that require input from doctors and caregivers. An answer to this is a POLST that can move with the patient no matter the health care setting.

The simplest alternative to deciding the best route one wants to take about end of life issues is offered by Harriet Warshaw, executive director of The Conversation Project. This is a national campaign to have people talk about end of life care openly and with no reservations. It aims to have families and friends converse about how they want their final days to be. It can be as simple as whether they want to remain at home or in a hospital or as complex as whether they want aggressive care or little other than food and water in a health care setting. Warshaw says people’s wishes for end of life care need to be “expressed and respected.”

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