National Healthcare Decisions Day – April 16, 2015

April 16th this year is National Healthcare Decisions Day (NHDD), which is a day to think about and prepare or update your advanced directives for healthcare.  It’s a great gift to your family and friends to let them know your wishes in case of health crises in which you may not be able to speak for yourself.  It’s comforting to you to know that you’ve discussed the circumstances and interventions that would fit with your values and desires for your future.  It reduces family discord to have a designated patient advocate who has a written document with your decisions about treatment.  It’s also hard to think about and talk about such frightening eventualities.

There is a website about NHDD that helps make it easier to undertake those conversations and to execute the relevant documents.   It lists a number of websites in which to find state-specific advanced directives forms.  It also has links to many sites that help facilitate family conversations about health crises and each person’s wishes, including some card games and a phone app to store advanced directives for yourself and loved ones.

The American Bar Association’s Commission on Law and Aging also has a number of helpful resources on preparing advanced directives and serving as a patient advocate.  There’s a guide to completing a universal health care power of attorney form, a guide to making medical decisions for another, and a toolkit that invites you to think about the various factors involved in coming to a decision about your possible care if you were faced with a serious medical condition.

Try not to put it off again this year.  My colleagues in the senior ER are begging us all to help them to help us and our families go through such harrowing experiences in a way that honors the person at risk and helps us all have greater peace of mind.

Sue Sweeney, Chair, Department of Aging Studies, Madonna University

End of Life Discussions

I agree with nurse Tom Deegan, who writes for the Huffington Post Healthy Living blog, in a recent post that we need to have more discussions about end of life in healthcare, but without the sensationalism of either “death panels” or assisted suicide.  I would guess the majority of cases revolve around very sick, even unconscious, patients, their overwhelmed families, and overworked doctors.  These are not conditions that are likely to produce reasonable, humane, and ethical decisions about life altering and, yes, extremely expensive treatment.  While advanced directives help, they are not the only answer and do not help with all situations.  For example, my father-in-law, who had terminal cancer, did not want life prolonging measures.  However, he had agreed to be placed on a ventilator only for surgery on ulcers that resulted from the steroids he’d been taking.  He did not recover consciousness after the surgery, and the physicians would not remove the ventilator.  His patient advocates were helpless to change the doctors’ decision.  Discussions in hospitals about how to handle such situations would reduce a lot of emotional upheaval for both families and healthcare providers.  Clinical peer review is a long established practice in healthcare.  What if the hospital convened a multidisciplinary team to review cases where end of life care was unsatisfactory, so that they could derive better solutions for the next time such a situation arose?  It would take time and some resources, but everyone would benefit.  In the long run, it might even save the hospital money.  Sue Sweeney, Chair, Gerontology Department, Madonna University