Go to Comments
This is the third in a series of eleven articles to educate and prepare ahead of time for loved ones or self for the end of life - This post is one of the most important in preparing so that during the transition time one can be on autopilot to some degree -- the mental and emotional functioning is greatly challenged by a draining of energy and focus --
Making decisions about finances - pain management - or comfort cannot be made wisely when in the midst of a critical physical and emotional state - This post addresses getting panels in place NOW for the ease of carrying out wishes and details at the appointed time -- Getting your own panel of family and caring friends to help during the tough times Comments will be open and available for viewing upon approval
Why We Should Create Death Panels By Carolyn McClanahan 12/14/2011
Healthcare is a complex system and change occurs from many angles. The Affordable Care Act attempts to influence it from the top down.
As individuals, we have a lot of power to fix it from the bottom up. It will take many people to institute positive change, and we will need to act like a flock of birds shifting direction in unison to have the most impact. One change is for each of us to create our very own individual “Death Panels.”
My focus this week is end of life decision making.
Read More Link On Right
How our health care system deals with the end of life needs repair as it can be heartless, painful, and extremely expensive. After posting my end of life wishes, a number of people pointed me to groups working hard to raise awareness and create action on this important issue. Before I share those with you, I will review the stumbling blocks with end of life discussions from a number of viewpoints.
We experience people around us getting sick and/or dying, and know it will happen to us one day, just not any time soon. So we nervously laugh and say, “Don’t let that happen to me” and never write it down.
When sickness suddenly happens and you have tubes hanging from almost every orifice, unable to declare your wishes, your family will say, “I don’t think Mom would want that.” But no one can really remember details. The family argues, and doctors continue to add more tubes because the stars aligning the health care system set it up that way.
The family of sick people:
Distance has significantly changed family structure and interactions. We Skype, call, email, text, and sometimes visit. Time for deep, heartfelt conversations is rare. One family member is usually responsible for looking after elderly parents. The rest check in periodically, may help financially, and stay distanced emotionally.
When crisis happens, if preparations have not been made, the family struggles greatly and decision making is difficult. In medicine, we practice crisis response regularly because when a crisis happens, it is hard to think.
Preparing in advance helps us move through the right motions on autopilot so we don’t have to think so hard. Families need to prepare in the same way.
The health care providers:
Being caught in the middle is a challenge. Doctors want to do the right thing for patients, and the system has made it very difficult to do so. We know the probability of outcomes, and since we are not God, we cannot know for certain if a miracle will occur. Ken Murray recently wrote a beautiful article titled, “How Doctors Die.”
Doctors experience these stories every day, which helps us make informed choices. “Regular Folks” rarely get that opportunity. In addition, media sensationalizes the rare good outcome, and this becomes the expectation.
There are multiple forces physicians have to deal with:
If families are in unison with the patient’s wishes, it is more likely the wishes will be followed. If the family is not unified, doctors will “do everything” until a consensus is reached, which may take a very long time. A family that is satisfied with the care and felt the doctor “did everything” is less likely to sue even if there is a bad outcome.
If we do not honor the family’s wishes, they become dissatisfied or angry. They complain, which may lower our “approval” ratings, patient satisfaction scores, and possibly our future income.
Doctors are paid more when they do more. This truly is not the overriding motivation. But especially since the patient doesn’t pay the bill, there is no incentive to keep costs low. Tests are ordered routinely and labs are “followed” even though they may have no bearing on outcome.
It is important to “do everything” just in case there is a review. “Protocols” are instituted even if they make no sense for the particular situation. Doing too much is always the safest approach, regardless of the actual benefit.
It is emotionally draining and time consuming to educate the family on what is happening with their loved one, especially if they are not primed to hear it. There is not much reimbursement by insurance.
Yet, studies show that end of life discussions help reduce wasteful spending and improve the “quality” of death in the final days of critical patients. Gratefully, most doctors still try really hard to get the message through to the family. We need to provide more incentive, support, and better protection when physicians have these hard conversations.
So what is the next step? There are many groups leading the discussion. Hospice and palliative care organizations are raising awareness, both nationally and in communities. Engage with Grace is a great site to begin conversation and start documentation and Aging with Dignity provides a good example of a living will, Five Wishes.
To form the flock needed to institute big change, a coalition has started National Healthcare Decisions Day – April 16th of each year is set aside for us to have heartfelt end of life conversations. They have support from all 50 states and multiple organizations.
One noticeable nod of support that is missing – a Presidential Declaration making April 16 the National Healthcare Decisions Day. I have a feeling if our president makes this declaration, the “Death Panel” bandwagon will raise their voice once again. An election nightmare, so it probably won’t happen soon.
Do the “Death Panel” people not see the opportunity in creating this day? We get to create our own “Death Panel” who decides our end of life choices – our family and friends. And we get to instruct them on how we wish our last days to be – whether that is “doing everything” or staying comfortable at home with people we love. Free choice is a wonderful thing and even better when there is education behind it. Up next - “Not Ready to Die? Who Should Pay?”
_We added a Wise Words page to our blog in hopes of contributing encouragement and inspiration during positive happy times as well as emotionally hard times --
Frustration - anxiety - and disappointment can easily creep in and take over our positive outlook with the waiting of the fruition of this investment and especially if one is experiencing a financial crisis or an emotional trauma --
A strong mental attitude is a great tool when faced with either of these - Wise Words are a great aide in strengthening the mental attitude --
Please take a few minutes to read over the quotes and allow them to sink in so you can ponder on them and be encouraged and strengthened by them --
We certainly appreciate and welcome comments on our Wise Words Page and enjoy posting them for others to see -- Thank you in advance for taking just a few minutes and sharing your thoughts on our Wise Words Page