Thoughts about Advanced Directives

I just finished reading Atul Gawande’s book, Being Mortal.  It’s about end of life issues from a physician’s point of view.  Though Dr. Gawande is not an internist, gerontologist or palliative care specialist, he is a thoughtful surgeon who needed to deal with difficult decisions for his patients and his own family.  He discusses a situation wherein the patient, a highly educated academic, who has made his daughter his healthcare power of attorney, becomes ill.  The daughter and father talk about the prognosis and she realizes that she doesn’t know what her dad really wants.  So she asks and is surprised to hear that he wants treatment if he can engage in the pleasure of two situations (chocolate ice cream and football) neither of which he had ever indicated an interest.  This out- of- the- blue declaration became her measure for agreeing to surgical procedures for her dad.  He lived an additional two years.   Had she not specifically asked the question about what was important to him, she would have let him go earlier. 

I found this description in the book to be particularly poignant.  We don’t know what another person is thinking unless we ask.  And more importantly, we must listen.  And when we listen, really listen, we open up new avenues of knowledge. 

Most hospitals have some type of form for advanced directives.  I can’t imagine what it would be like to be faced with completing the form when I am in a state of crisis.  Would I check all the boxes that would keep me pain free or would I want any and all forces to be used to keep me alive?    Having already had this conversation with myself and my loved ones I am comfortable with my own decisions.  These are tough questions to answer.  Sort of like creating a fantasy of what could take place and wishing it never would. 

For people on Medicare, a change in the benefits may help individuals address the difficult subject of “what happens if…”.  Beginning January 1, 2016, Medicare will pay for voluntary discussions of end-of-life issues between the patient and the physician.  According to the Pittsburgh Post-Gazette of November 28, 2015, Medicare will reimburse physicians up to $86 for a 30 minute discussion about the choices for a terminally ill patient.  As more and more medical schools prepare doctors to get comfortable with this topic, the culture will change.  Let’s not wait.  If you have not thought about this, the time is now.  Educate yourself, talk with your physician, and then talk with your family.  This is one topic that does not lend itself to delegation.  You must take the initiative.

Image: James Daisa