Encourage End of Life Discussions:

Conversations Between Patients, Families, and Physicians

Physicians for Reform believes in the intrinsic value and dignity of human life regardless of age or medical condition. All patients deserve to be treated with the utmost respect at all stages of life.

End-of-life decisions must remain in the hands of patients, their families, and their physicians, not the State. However, patients and physicians must be willing to discuss end-of-life care. If we do not accept this responsibility, Washington will make these decisions for us.

While this highly complex and difficult subject deserves a book rather than a paragraph, here some thoughts to guide the discussion…

·    Primary care physicians and physicians caring for patients in nursing homes should be encouraged to discuss advanced directives with their patients and their patient’s families.

·    Medicare should reimburse for a 30-minute discussion of advanced directives once every five years for patients over 65. This would allow physicians caring for seniors to block out time specifically to discuss this important and sensitive subject. This is not a matter to bring up during a 10-minute routine follow-up visit.

·    Advanced directives should not be discussed in the context of the cost of healthcare. Discussing healthcare finance in this setting immediately changes the tone of the discussion.

·    Patients and families must know their wishes will always be respected.

·    Most patients and families have never discussed advanced directives with their physician. The vast majority of patients appreciate the chance to ask questions and make their wishes known.

·    Two questions are particularly helpful for family members of unresponsive loved ones with severe, end-stage chronic disease:

      1) What would the patient want if he or she could wake up and participate in the conversation?

      2) If we decide on aggressive medical intervention, are we doing this for the patient? Or are we doing this to the patient and for ourselves? Ourselves sometimes is the physician, sometimes the nurse, and sometimes the family.

·    The role of the family is not so much to decide what should be done, but to speak for the patient if he or she is unable to speak for himself or herself. The family’s primary role is to help the physician understand what the patient would want done in that particular circumstance.

·    Physicians should encouraged patients to appoint a healthcare power of attorney. When the general wording of a “living will” does not match the exact medical situation at hand, a healthcare power of attorney is often the best way for a patient to be certain their wishes are followed.