Sunday, March 9, 2014

Respecting Wishes - Advanced Care Directives Ensure Your End-of-Life Wishes Are Carried Out

Lacrosse, Wisconsin is a picturesque city of just over 50,000, nestled on the banks of the Mississippi about an hour southwest of Minneapolis/St. Paul. Besides its natural beauty and the friendly charm of a small town, Lacrosse has also become a place where people don’t shy away from death. In fact, they talk about it and embrace it as a part of life.

An amazing 96% of the people in Lacrosse have planned for end-of-life issues by putting advanced directives in place. This is a startling statistic given that the nation average is only 30%.  Now other cities across America are looking to Lacrosse, Wisconsin for guidance in developing their own programs for end-of-life planning, also known as advance directives.

It has taken a long time for the issue of end-of-life decisions to make its way into national news, both socially and politically.  Death is not an easy topic and many shy away from discussing it.   As Lynn Keegan and Carole Ann Drick note in their book, The Golden Room: A Practical Guide for Death with Dignity, “[f]or many death is one of the most difficult things to talk or think about. It is a subject that is not part of normal conversation and scary to many. With proper preparation everything will fall into place in the most kind and gentle manner as possible. It requires a shift in attitude so that dying is accepted as a sacred process deserving of compassion, dignity and beautiful surrounding AND available to everyone not just a select few. This is relevant to everyone as we will all die. People need basic ideas of what to expect and how to plan right up to the end. Death is a part of life. How did we ever allow advanced technology to take the place of the old and timeless values of compassionate end-of-life care?”  

The discussion of advance directives has much to do with an individual’s quality of life in his or her final days. Does he or she want to be kept alive on a ventilator or feeding tube when all else has failed? It is fair to burden a family with having to make a difficult decision to let Mom or Dad die?  Is living in a vegetative state or without full usage of one’s faculties something a person might want? And more simply, does the individual want to be cremated or buried?  These are decisions best made in advance.

The discussion of end-of-life issues is becoming more common thanks to a man by the name of Bud Hammes. According to a recent broadcast on NPR, “Some 20 years ago Bud worked at the dialysis center of a LaCrosse hospital.  He discovered only two of the 60 in the center had living wills that specified whether they wanted to be kept alive on machines.  Bud started giving nurses complete training on how to produce an advanced directive with a patient.  It was a long and hard road for Bud. At the start the nurses felt just as uncomfortable as the patients in talking about the inevitability of death and the necessity to plan for it.  Finally, the nurses came to accept it and now these discussions are a daily routine.”

Planning ahead through the use of advance directives also saves money. One quarter of healthcare spending is in the last year of life. That spending goes to hospitals and doctors.  Of the 306 regions in a recent Dartmouth study, Lacrosse spends less on health care than any other place in the country.  This is a direct result of end-of-life planning as fewer people burden themselves with costly medical care which will not provide them with quality of life at the end of their days. 

Many states – including Indiana -- are now turning to LaCrosse in an effort to duplicate its success.  They are reaching out to Bud Hammes to ask him “How do we get people to plan for death?”  A new pilot program in northeast Indiana called Respecting Wishes is modeled after Bud Hammes’ program in LaCrosse.

Respecting Wishes trains of physicians, nurses, and other key medical personnel to discuss advanced care planning with individuals.  A standardized curriculum is being developed to train the members of advanced care planning teams to ensure the delivery of a consistent and reliable advanced care plan, to assist patients with an informed, timely, and specific decision-making process, and to promote timely and appropriate referrals to other needed services.  The goal is to ensure clinical care is consistent with the individual’s wishes, improve the decision-making process by facilitating shared decision-making among patient, physician and the patient’s representative, and to improve patient outcomes.  It is the hope that this program will be adopted in other Indiana counties if the pilot is successful.

If you are interested in ensuring that your end-of-life decisions are documented, Indiana offers the following advanced directives:

Medical Power of Attorney/Appointment of Health Care Representative – allows an individual to appoint a representative to make health care decisions for him or her if he or she becomes unable to make health care decisions for himself or herself.  These decisions include such issues as consent to surgery, access to medical information, release of medical information, choice of a physician, choice of a facility or provider of services, admission to a facility, and withdrawal or withholding of medical care.  A few decisions may also be made after an individual’s death, including decisions about organ donation, whether or not an autopsy should be performed and funeral arrangements.

Living Will – a Living Will allows an individual to state whether or not he or she wants his or her life artificially prolonged by tubes and machines.  In order to be effective, the individual’s attending physician must certify that: 1) he or she is suffering from an incurable injury, disease or illness; 2) his or her death will occur in a short period of time; and 3) the use of life-prolonging procedures would serve only to artificially prolong his or her life.  If those three provisions are met, the individual may elect to have life-prolonging procedures, such as ventilators and artificially supplied nutrition and hydration, withheld or withdrawn so that he or she may die naturally with only medical procedures or medication necessary to keep the individual out of pain and comfortable.

Life-Prolonging Procedures Declaration -  The opposite of a Living Will, a Life-Prolonging Procedures Declaration allows an individual to indicate that if he or she is suffering from an incurable injury, disease or illness determined to be a terminal condition, he or she requests the use of life prolonging procedures which would extend his or her life.

POST (Physician’s Order Scope of Treatment) – Indiana’s newest advanced directive, a POST is completed by the individual or his or her representative with his or her physician if the individual is suffering from a chronic or terminal illness or chronic frailty.  POST allows the individual to be specific about the types of care he or she wishes to receive under the circumstances, including CPR, antibiotics, the level of medical intervention desired (minimal to full), and pain medication.

Funeral Planning Declaration – Indiana also has its own Funeral Planning Declaration form allowing an individual to appoint a representative to carry out his or her wishes for his or her funeral.  The form allows the individual to be specific about the type of funeral and burial he or she may want, including burial, cremation, time and place of service, choice of funeral home, and any other specific directives the individual may wish to include about his or her funeral or burial.  In the absence of a funeral planning declaration, the individual designated to serve as the health care representative is in charge of funeral planning decisions under Indiana law.


For more information about advanced directives or to get assistance with your end-of-life planning, contact Geyer & Associates at 317-973-4555 or www.rgeyerlaw.com.