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END-OF-LIFE
ISSUES
weakness, shortness of breath, difficulty thinking and other prob- • IT IS A GOOD IDEA TO REVISIT YOUR PRIORITIES
lems. While more than 90 percent of people state a desire to die at IF YOUR HEALTH CONDITION OR LIFE CIRCUM-
home when the time comes, most of us will die in the hospital, STANCES CHANGE DRAMATICALLY. It is also a good
most often in the ICU. No one volunteers for this outcome; it is idea to discuss your overall health picture with your doctor. He
preventable with open discussion and planning. Further, before or she can advise you about the pros and cons of treatments.
2008, the majority of personal bankruptcies were related to health-
care costs. This, too, is a preventable outcome. ADVANCE DIRECTIVES
If you choose to fill out a living will (in Texas it is called a “di-
UNWANTED OUTCOMES
So how can one prevent unwanted outcomes? Some suggestions rective to physicians, family and surrogates”), the forms can be
found online at http://www.dads.state.tx.us/news_info/publica-
follow. tions/handbooks/advancedirectives.html.
• ASK MORE QUESTIONS. We have a natural tendency to
You need only two witnesses to verify you are the one who has
focus on the HOPED FOR outcomes, but not the LIKELY signed it. There is no need for a notary or a lawyer, so there is
ones. By understanding what treatments can and cannot do for no cost. Discuss the document with your doctors on your next
you, you can make informed decisions and often avoid surger- visit as well.
ies, medications and ICU stays that will not produce the results
you want. HOW HOSPICE CAN HELP
• HERE ARE SOME QUESTIONS TO ASK: What are the Hospice care focuses on helping you and your family live as well
likely short-term benefits from this treatment? What are the
short-term problems? What are the long-term benefits? What as possible when you have a limited life expectancy. You are quali-
are the long-term problems? What will the treatment do to fied to receive hospice if you have a life expectancy of six months
my ability to think clearly? To my energy level? How much or less.
pain will I have and for how long? Will I regain my independ- • There are no out-of-pocket costs for Medicare and Medicaid
ence? When you advise I should have a good response to treat-
ment, what do you mean by that? (Will I be cured?) patients and for most who have insurance as well.
• DISCUSS OUTCOMES WORSE THAN DEATH — your • Hospice caregivers are experts in relieving distress, whether it is
fears, hopes and concerns — with your family and healthcare
providers. In particular, discuss your views of the value of being physical symptoms, spiritual concerns and issues of loss, grief
permanently unconscious and whether you would want your and meaning, or other practical needs.
life prolonged in that condition. • A package of services and not a place, hospice can be delivered
• DON’T WAIT FOR THE DOCTOR TO BRING IT UP. wherever you are. Most hospice care is rendered in your own
Doctors think the patient and family are “not ready” to discuss home or in a nursing home.
the potential for dying until the patient is already in the ICU • Hospice professionals, including nurses, aides, social workers,
filled with tubes. chaplains and physicians, visit by appointment. They are avail-
• CHOOSE SOMEONE TO SPEAK FOR YOU IF YOU able by phone and on call to come to you if needed to assist
CANNOT SPEAK FOR YOURSELF (designate a “medical with problems 24/7.
power of attorney” or surrogate decision-maker) and tell him • Your medications and any medical equipment needed for your
or her your priorities for healthcare. Ask if they will uphold your illness are delivered to your residence.
preferences. • For severe symptoms, short-term inpatient hospice care or eight
• FAMILY GATHERINGS AND HOLIDAYS, WHEN to 24 hours per day of nursing care is provided in the home
EVERYONE IS TOGETHER, CAN BE GOOD OPPOR- until the symptom is under better control. This service is often
TUNITIES TO DISCUSS THESE ISSUES. Despite having needed as the end gets nearer.
a surrogate, it is best for all concerned to have heard it from you • Respite care is also available if your family gets exhausted and
directly. needs a break. Other family-centered services include assistance
coordinating benefits, making healthcare decisions and the pro-
vision of grief support for 13 months after death.
Continued on page 14
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