There is a great article in the NYT in which they interview a now retired physician Robert L. Martensen about the state of health care. He observes that “most Americans die in hospitals or nursing homes, and neither is configured to take care of dying patients.” So you end up with situations where extra-ordinary measures are taken so that the patient or nursing home resident ÛÏdoesnÛªt die on my watch.Û There is a fine line between hope and reality as he points out. And that means acknowledging when all that has been done is done. He furthers points out the enduring pain we cause those by trying to keep them alive for a quality of life that is questionable. For example, if you resuscitate an older person, you may break their ribs during C.P.R. If you put them on a ventilator, you may end up sedating them so heavily they are barely conscious.
We all want to live as long as possible and I think I speak for most when saying we want to live that life with quality.
So having a living will and a durable medical power of attorney is absolutely imperative.
Simply stating that you do not want extra-ordinary means taken for your care will not stop caregivers from trying especially if they are concerned with lawsuits and quality metrics like mortality rates. And as the good doctor points out even with written directives in place he has seen hospitals still try to revive patients who have clearly specified otherwise.
A quick to-do list:
åá Put together a living will
åá Put together a durable medical power of attorney
åá For a great book on this, see my friend Jo Kline Cebuhar, J.D., author of
Last things first, just in caseÛ_The practical guide to Living Wills and Durable
Powers of Attorney for Health Care
Of course this has some underlying issues and 800 pound gorillas in the room. The simple fact is we donÛªt talk about what it means to grow older in this country let alone what it means to die with dignity. We need too.