Wednesday, September 7, 2011

Just Say When: Why Don’t More People Have Living Wills?

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Only about 30 percent of us have prepared a healthcare “living will” to give loved ones and healthcare providers our intentions for medical care when we can’t communicate and are close to death.

This seems to be another paradox to the notion that we are moving towards healthcare consumerism, a world in which people want to take a more active role in their care.

If there is ever a good time to have a say in your care, it is at the end of life when families tend to be the most dysfunctional, providers are looking for guidance and the costs are highest.

Why do so few people take the opportunity to exercise control?

“We don’t do death very well in the United States,” says Sherry Henry, an advanced practice nurse who provides palliative care, or end-of-life care, at Piedmont Hospital. People tend to be uncomfortable talking about dying and reluctant to think about the realities of something that will happen to all of us, she says.

Hospitals and other healthcare institutions are required by federal law to promote and support the use of living wills, commonly called healthcare advance directives. Patients at Piedmont are asked on admission if they have a living will and, if they don’t, if they would like free help in preparing one.

Nate Brown, a lead patient representative at Piedmont, estimates that he is called to complete about 25 advance directives a month for patients and their families. Depending on how much the patient has thought through the answers in advance, it can take from 10 minutes to an hour. Occasionally he is contacted by people in the community, who aren’t hospital patients at the time, and he will complete the advance directive for them and keep it on file.

The advance directive, a legal document, lets the patient voice their wishes, even when they can no longer speak. “It is so wonderful when you can ask a patient what they want,” says Sherry Henry, referring to having the advance in hand for a patient who can no longer communicate, when family and providers are struggling with what to do next.

Doctors are trained to keep people alive, says Dr. Leigh Hamby, a board certified general surgeon and the Chief Medical Officer for Piedmont Healthcare. The healthcare system is generally programmed to keep our heart beating by any means necessary, unless we say that it is okay to stop.

My grandmother decided it was time to stop in her mid-80s after seven years on kidney dialysis. With her quality of life diminishing and her body rapidly failing, one day she told her doctors that she wouldn’t be continuing her three-times-a-week dialysis treatment. The decision meant that within days she would go into a coma and die.

After an initial attempt to change her mind, the doctors agreed and the staff at the nursing home did all they could to make her comfortable. Family flew in from all over and enjoyed several days of visiting and sharing a lifetime of memories before my grandmother gently went to sleep.

Sometimes being a good consumer is about knowing when to say “enough.” Unfortunately, many of us wait until it is too late.

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  1. Pat Lovern
    Posted September 8, 2011 at 5:04 pm | Permalink

    I hope that 30% will increase to 60-70% assuming the total population is included. It wasn’t until I was in my late 60s that I decided to do a living will and I realize now that it should have been done years sooner. Sadly, most of us don’t think about our health as if it is in jeoprady when we are in our 40s and 50s. I would hope the percentage for those over 65 would be 90%.

  2. Michael Rovinsky
    Posted September 8, 2011 at 7:39 pm | Permalink

    Is there any connection between how relatively few people have prepared a healthcare living will and the demonization of end of life couseling that occured during the debate over Health Care Reform? It seems that considering one’s options at the end of one’s life is still a taboo concept to a large segment of the population. In effect, living wills may represent written death squads.

  3. Mendal Bouknight
    Posted September 13, 2011 at 11:33 pm | Permalink

    In keeping with this concerning number of people who don’t have Living Wills is how few people have Wills and estate plans. Your point about families being dysfunctional when a loved one is at the end of life is so true.

    It is unfortunate that much of this family dysfunction and emotion carries on after the loved one is deceased and did not have a Will. We all owe it to those we love to make provisions in a Will.

    Even a person with the most modest of possessions should prepare a Will. These two documents, a Living Will and a Will, go hand-in-hand.

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“Hi, I’m Ed Lovern, the executive vice president and chief administrative officer for Piedmont Healthcare in Atlanta. I created this blog to share my thoughts on the healthcare revolution and how we can all be part of the solution. Feel free to comment or email me your thoughts – I would love to have your contributions and feedback.”
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