MMS Physician Focus: April 2009
By Jack Evjy, M.D.
As a physician who has specialized in medical oncology for four
decades, I know well how death and dying can affect patients and
their families. End-of-life issues are never easy to discuss or
experience, but they reach every one of us at one time or another,
whether as a patient, a loved one, or family member.
While we may tend to avoid discussing death and dying,
particularly among family members, it's important to have this
conversation sooner rather than later. Preparing for one's final
days will allow those days to be filled with as much dignity,
respect, and quality of life as possible, especially if the person
has a serious or terminal illness. Preparation can also prevent
angst, regret and trouble among friends, family and loved ones who
may not remember your specific wishes. It should also provide peace
of mind that your wishes have been communicated and will be
honored.
Most people recognize the need for a will, to ensure that
possessions are left according to one's desires. Yet other
important documents should be completed as well, and terminology is
important. Here are some of the basics, courtesy of the Hospice
& Palliative Care Federation of Massachusetts.
Advance Directives is a general term referring to
instructions about your future medical care, should you become
unable to communicate those instructions yourself. Typically,
directives include a living will, durable power of attorney, and
health care proxy.
A living will, variously called 'directive to
physicians' or 'declaration of health care,' specifies the kind of
life-saving or life-sustaining care you want or don't want in the
event you become incapacitated or terminally ill. While
Massachusetts considers this kind of document good evidence of a
patient's wishes, it's not legally binding in the
Commonwealth.
A durable power of attorney for health care is a legal
document appointing someone to act on your behalf in deciding on
medical treatments in case you become incapacitated.
A health care proxy is legally binding in Massachusetts
and lets you name a person of your choosing to make health care
decisions for you -- according to your instructions -- if you
cannot do so for yourself. A health care proxy is the critical
first step to ensure that your care will be consistent with your
beliefs and values and that your final wishes will be
fulfilled.
A values history form, though not a legal document,
states the values and beliefs that matter most to you and can
provide important direction for others who may have to make
decisions for you.
If serious or terminal illness exists, preparations should
include an examination of hospice and palliative care, a medical
specialty dedicated to relieving the pain and suffering of patients
and providing them with the best quality of life
possible.
Offering a customized approach to care, these programs include
medical, social, and health specialists working as a team with the
primary care physician, creating an individualized treatment plan
that benefits patients and families. Hospice and palliative care
can be provided when the goal of care changes from cure to comfort
during a person's illness and includes expert treatment of pain,
guidance with treatment choices, and emotional support for the
patient and family. Hospice care also provides bereavement support
after a loved one's death.
For more on end-of-life issues, visit the Hospice &
Palliative Care Federation of Massachusetts at www.hospicefed.org. This
comprehensive site includes clear explanations on many topics,
including advance care directives, pediatric programs, advice on
choosing a hospice, and information for families. It also includes
a list of hospices and palliative care programs throughout the
state, access to a healthcare proxy form, and instructions on how
to complete it.
Other valuable sites are www.nationalhealthcaredecisionsday.org,
a national initiative on healthcare decision-making, and
http://www.lawlib.state.ma.us/subject/about/healthproxy.html the
Massachusetts Trial Court Library.
Jack Evjy, M.D. is Medical Affairs Advisor for the
Massachusetts Medical Society and a member of the Massachusetts
Health Care Quality and Cost Council's End of Life Expert Panel.
Physician Focus is a public service of the Massachusetts Medical
Society. Readers should use their own judgment when seeking medical
care and consult with their physician for treatment. Comments
to PhysicianFocus@mms.org
.
