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The Need to Plan for the End

Recently, a friend sent to me an article from the Wall Street Journal dated February 25, 2012.  The title of the article was “Why Doctors Die Differently.”

Although not specifically mentioned in the article, most of the Medicare spending for a person occurs in the last months before their death.  Usually, that spending outweighs all previous Medicare spending on that person.

In the article, a respected orthopedist discovered that he had pancreatic cancer.  There was a procedure available that would triple a patient’s five-year survival odds from 5 to 15 percent, although with a poor quality of life.  The orthopedist decided that he was not interested.  He went home the next day, closed his practice and never set foot in a hospital again.  He focused on spending time with his family.  He received no chemotherapy, radiation or surgical treatment.  Several months later, he died at home.  Medicare did not spend much on him.

The article points out, just like us, doctors die too.  What is unusual about them is not how much treatment they get compared with most Americans, but with how little.  They know exactly what is going to happen, they know the choices, and they generally have access to any sort of medical care they could want, but they tend to go serenely and gently.

Sixty-four percent of all doctors have advance directives – specifying what steps should or should not be taken to save their lives.  The article points out that only 20% of the general public has such advance directives.

The article goes on to point out some interesting facts.  We have all seen CPR on TV.  We see CPR performed that is successful in 75% of the cases and 67% of TV patients go home.  In reality, a 2010 study of more 95,000 cases of CPR found that only 8% survive for more than a month.  Of these, only about 3% could lead a mostly normal life.  The article points out that even physicians are reluctant to discuss end of life decisions with their patients.

According to the article, “the result is that more people receive futile, life-saving care and fewer people die at home than did say, 60 years ago.”  As the article points out, written directives can give patients far more control over how their lives end.

It is critically important to discuss end of life decisions and to have written directives.  You need to be in control of your end of life decision making.  You need to dictate what is an acceptable quality of life and what is not an acceptable quality of life.  Quantity does not equal quality.

Be sure that your doctor has your choices in his records.  For me, there will not be heroics, but I want to be able to pass according to my wishes and as gently as possible, and as pain-free as possible.

If you have not made your written directives, please take care of it.


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