MMS Physician Focus: April 2010
By Prescott Lee, M.D.
Physicians undergo years of education and training to promote
wellness, cure illness, and preserve and protect life. But we're
also conscious of the inevitability of death, and in recent years,
we've been paying more attention to end-of-life issues. It's
important for us to do so because it's important for our
patients.
As a physician who specializes in geriatric medicine, I am
acutely aware of how death and dying affect patients and their
families. I am amazed when an 80- or even 90-year-old reports to
me, after raising the topic, that he or she has never had a
physician ask them about end-of-life issues.
End-of-life issues are never easy to discuss, but such a
dialogue is critically important for families. Preparing for your
final days, especially if the patient has a terminal illness, is
prudent, to specify to family members what your end-of-life wishes
are and to prevent confusion, regret or trouble within families.
Preparation also provides peace of mind for you, knowing your
wishes will be honored.
While conversations between family members are essential,
talking with your primary care physician is also important. He or
she needs to know what steps you wish to be taken or not taken
should you find yourself in a critical medical condition or become
unable to make decisions for yourself.
We all recognize the need for a will, to ensure that our
possessions are left according to our wishes. But comprehensive
end-of-life planning calls for additional documents. Here are the
basics, courtesy of the Hospice & Palliative Care Federation of
Massachusetts.
Advance Directives refers to instructions about your
future medical care, should you become unable to communicate those
instructions yourself. Such directives include a living will and
durable power of attorney or health care proxy.
A living will, sometimes called a '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.
A health care proxy, or durable power of attorney
for health care, designates a person of your choice to make
health care decisions for you if you cannot do so for yourself. A
health care proxy, legally binding in Massachusetts and many other
states, ensures that your care will be consistent with your beliefs
and values and that your final wishes will be fulfilled.
If terminal illness exists, you should also 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. Hospice and
palliative care is provided when care changes from cure to comfort
during someone's illness. It includes expert pain treatment,
guidance with treatment choices, and emotional support for the
patient and family.
As with most important decisions, having the right information
to act on is critical. Here are some good resources.
The Hospice & Palliative Care Federation of Massachusetts at
www.hospicefed.org is a
comprehensive site that includes clear explanations on a variety of
end-of-life issues. It also has a list of hospices and palliative
care programs throughout the state.
The Massachusetts Medical Society at www.healthcareproxy.org
provides a healthcare proxy form and step-by-step instructions on
completing it.
Aging With Dignity at www.agingwithdignity.org
presents Five Wishes, a living will that answers five simple, but
vital questions: who you want to make health care decisions for you
when you can't make them, the kind of medical treatment you want or
don't, how comfortable you want to be, how you want people to treat
you, and what you want your loved ones to know. The Five Wishes
document, available in 26 languages, meets legal requirements in 42
states and is useful in all 50.
Finally, the Massachusetts Trial Court Library at http://www.lawlib.state.ma.us/
provides links to Federal and state laws and regulations pertaining
to durable power of attorney, health care proxies and other advance
directives. At the site, use the search function for 'health
care.'
Just three years ago, scores of national and local organizations
came together to create National Healthcare Decisions Day, now
celebrated every April 16, with the goals of raising public
awareness about and providing a call to action for people on
end-of-life issues. If you missed the day, that's ok. For
those who haven't acted, the time to act isn't restricted to a
single day. The time should be now.
Prescott Lee, M.D., is chair of the Massachusetts Medical
Society's Committee on Geriatrics, staff physician at Brooksby
Village Retirement Community in Peabody, Mass. and Attending
Physician and Infectious Diseases Specialist at North Shore Medical
Center in Salem, Mass. 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 toPhysicianFocus@mms.org
.
