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Article

Discussing End-of-Life Choices with Your Doctor

By Rita Dichele, June 29

As you might recall from my previous articles, end of life care encompasses many issues and steps to take in order to secure our wishes on how we may want to die.  In other words, we might have an advance directive, a document that states our instructions regarding what medical measures we want taken as we near the end of our lives.  End of life care is certainly not a “death panel” determination regarding who should live or not live based on a medical condition. Once we have identified the “triggers” that cause us to become aware of our own mortality, it might be time to have a conversation with our physician. Keep in mind you may be the one who has initiated the office visit and that your time is limited.  For instance, Medicare reimburses for a 30 minute visit.  Therefore, it is important to remain focused and stick to your preparation notes and/or advanced directive document. PREPARING FOR THE CONVERSATION As you prepare to speak with your physician and/or nurse practitioner or physician assistant, it is very important to understand what you want to discuss and why.  It can be confusing; especially because health care providers often use acronyms to discuss the terms related to end of life planning/care.  Therefore, I recommend highly being prepared and having your homework completed before you have the conversation. Below are some questions to consider that you might want to discuss. QUESTIONS TO THINK ABOUT What are your overall goals and types of medical care you prefer as you near death? What is a perfect day like for you? What does quality of life mean? How do you envision the last few days of living? Do you want to die at home with hospice care? What does putting your final affairs together mean? What are your religious beliefs and values surrounding death? Do you have an advanced directive?  If so, have you updated it to reflect your current wishes? GLOSSARY OF TERMS Knowing and being familiar with some of the life sustaining terms prior to the conversation will prove to be helpful and an effective use of time with your physician. AHN:        Artificial hydration and nutrition CPR:         Cardio-pulmonary resuscitation CC/DNR:  Comfort care/do not resuscitate verification protocol DNH:        Do not hospitalize DNI:          Do not intubate DNR:        Do not resuscitate POLST:     Physician ordered life sustaining treatment POLST                During the conversation a documented POLST form signed by the physician and/or patient and legal guardian (health care proxy; durable power of attorney, etc.) may be discussed. This documentation is a prescription that states what the patient or family members have discussed with their physician regarding life sustaining treatment such cardiac resuscitation, intubation for breathing, feeding tube, etc. The POLST form should not only be part of your office and hospital charts, but placed on your refrigerator so that first responders know how to proceed should CPR become necessary; especially if either you or your loved ones are home alone. FINAL THOUGHTS It can be extremely confusing for the patient and/or family members to understand during a medical crisis what steps should be taken to prolong life.  Even if you have an advanced directive and have discussed end of life care with your physician, there is always the uncertainty of the situation resulting in a change from your advanced directive.  This can be a tough request to make when either you or your loved ones appear healthy.  I remember when my father was being admitted to the hospital several health care providers were asking him if he wanted DNR orders.  My dad had a living will, a type of health care document similar to an advance directive, stating “do not resuscitate the heart”.  Even though my dad was lucid, he became confused and anxious with the frequent traffic of concerned health care providers asking him the same DNR question.  Finally, I spoke up and said, “he has a living will and please don’t ask him about DNR anymore”.  The doctor turned around and said to me “but sometimes they change their minds”.  On the other hand when my mother had an almost fatal heart attack with a 100% major artery blockage, she was cared for by the ER trauma team.  My mom was conscious and they asked her if she wanted DNR status.  Mom emphatically said “no” which was opposite of what she had in her living will. The physicians did perform CPR on her.  She was 83 at the time and lived until 91 with no further heart issues. With that being said, if we are conscious we CAN make our own decisions even if they do not correspond with our advanced directive and/or living will.  End of life documents are not written in cement; especially if you are conscious.  The documents are there to guide your medical care and help your family members/guardians facilitate your wishes. Rita Dichele holds three Master degrees in Counseling Psychology, Health Care Administration, and Human Services.  Ms. Dichele is certified in death & dying and bereavement from the Association for Death Education and Counseling (ADEC).  She is on faculty with A.T. Still University and instructs classes in grief work and long-term care.

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