Deciding medical care
We found our 85-year-old neighbor Claude dead on his kitchen floor with his tiny pet parrot perched on his shoulder. He was wearing a DNR (do not resuscitate) bracelet. Fire-rescue honored his request and made no effort to revive him.
Earlier his physician had talked with him about end-of-life options. Our neighbor said he wanted to die at home and in his bed. The physician said “at home” was manageable, but there was no guarantee about being in bed.
End-of-life topics are back in the news in the wake of some congressional suggestions to provide Medicare payments to encourage health providers to discuss those issues.
Conservatives, led by Sarah Palin, have pictured this leading to euthanasia or “death panels” of physicians refusing care to the elderly. Alas, many senior citizens are not as lucid as Claude was to the very end.T
he State Medical Society, the Wisconsin Hospital Association and the State Bar of Wisconsin addressed the issues years ago with a booklet titled “A Gift to Your Family,” which focuses on planning ahead for future health needs. The booklet is available free in most physician offices, clinics and hospitals.
The organizations urge citizens to provide either a “power of attorney for health care” or a “declaration to physicians” (or, “living will”) while the individual is competent. The power of attorney includes a description of your treatment preferences to guide the agent.
Issues include use of feeding tubes, surgery except to reduce or ease pain, avoiding radiation or chemotherapy except to reduce pain, kidney dialysis, erring on the side of over medication even if it increases death risks.
One provision would direct his agent to “ask questions and understand proposals, challenge assumptions and be prepared to say ‘no’ to care which I would not want and to demand care that I would want.”
It provides material about a terminal condition, persistent vegetative state and advanced dementia.
Delegating the authority, perhaps with guidelines, makes it easier on families that disagree on what should be done for senior citizens. Having one person in charge helps avoid family disagreements. Some one in the family may want to keep Grandpa alive as long as possible no matter what is involved. Grandpa himself probably would like a say in that issue.
Not all of the elderly have families with which to discuss these matters. Physicians end up being the educators about what is involved. The proposed Medicare language would have provided some payment, and thus incentive, for them to help seniors with future care questions.
The idea seems gone from the health care reform debate. Radio talk show chatter comparing it to Nazi Germany has taken its toll. The men and women who studied and studied to become physicians had the goal of doing good deeds. They surely have done well financially, but they want to do both good and well.
You can help them by getting the “A Gift to Your Family” booklet and discussing it with your family.
