Last year, new Medicare guidelines were proposed that would allow doctors to get reimbursed for holding voluntary end-of-life consultations with patients during annual medical checkups. It would have given specific directions to doctors on what they should tell patients, including discussion of palliative care, hospice and other services.

In early December less specific language watered down advance-care planning to nothing more than having a discussion about advance directives (living wills) that would tell doctors what to do if the patient is too ill to make medical decisions. Now the regulation will delete references to end-of-life planning as part of the annual physical examination.

The government still says you can and should have these discussion; however, it is voluntary. So likely not to happen if there is no reimbursement tied to it.

Well-meaning doctors and hospitals often treat patients aggressively, keeping them hooked up to machines and prolonging life at all costs, including the quality of that life. Some physicians understand the benefit of palliative care and hospice care but many more need to be educated about it.

We have to start having these end of life conversations in order to end life with a quality of life. You might start with questions from Alexandra Drane’s and her Engage With Grace: The One Slide Project. She poses five questions that you can answer for yourself online and use to help caregivers get the conversation started with their loved ones.

Adapted from my about.com blog.