The Commercial-News, Danville, IL

February 27, 2010

Don't delay decisions about care


When a family member is in the hospital with a terminal illness, many times arguments about the right course of action occur. This can lead to discontent and division among family members. I have seen this many times throughout my nursing career.

I am certain the patient would not want their relatives fighting; he or she would want them supporting each other during this time of grief.

The simple solution is for an advanced directive to be in place. When the patient is unable to speak on his own behalf, this document can help to clarify his wishes for end-of-life care and alleviate conflicts among family members. Advanced directives include a living will and medical power of attorney.

Discussions about death and the dying process are always difficult for patients, families, and health care professionals. This difficult subject needs to be addressed before the final days of life occur to provide the best approach to the process. Advanced directives can help to facilitate the choices patients have made. It is imperative that once these documents are initiated, they are discussed with family members and with the health care professionals assisting with medical care.

During the past year, the topic of end-of-life care has developed into debates about forced euthanasia. I believe that this has negatively impacted public perception of advanced directives and their benefit. In April, an annual national event takes place to encourage discussions about advanced directive planning.

Health care facilities that receive Medicare reimbursement have a requirement to ask whether or not patients have advanced directives and to provide advanced directive information and education. Upon hospital admission, patients are asked whether they have an advanced directive. In my experience, patients frequently believe that I am referring to their last will and testament and a power of attorney for their estate.

These encounters made me realize that the American public does not know about advanced directives. I do not believe that this is the proper time to facilitate learning about such an important subject. These discussions can lead to ethical issues and conflicts within the family at the beginning of a hospitalization.

Conversations regarding end-of-life choices should start in primary care. This is something that should be discussed before the occurrence of an acute problem. It should be discussed at every visit with the primary care provider, at which time appropriate resources can be shared with patient. Patients can then begin thinking about their choices before an acute hospitalization.

When advanced directives are in place, health care professionals are better able to carry out the wishes of patients. When these documents are not in place, health care providers are faced with legal and ethical dilemmas.

In many instances, full treatment is provided even when these measures are futile. In the instance of maintaining life sustaining treatments when they are futile, the cost is even greater than a monetary value. At some point, the quality of life needs to outweigh the quantity. With a terminal diagnosis, treatments to extend life incur a great cost to suffering for the patient and for the family of the patient.

I believe hospice care can increase the satisfaction of existing life for the patient and their family. Continuing futile measures can decrease closure for both the patient and their family.

In November 2008 false rumors about forced euthanasia in health care reform began and this culminated in the fall of 2009. The Senate then dropped voluntary consultation reimbursement for end-of-life planning from the bill due to these misinterpretations.

I believe that all of this media propaganda and the pressure felt by the government to drop this from the bill have led to an increase in public perception that advanced directives will keep them from obtaining needed health care services. This is completely false, advanced directives serve to let patients decide what should and should not be done.

National research shows that less than half of terminal patients have advanced directives, less than 15 percent of those that do have them had physician input when developing them, and that up to 76 percent of physicians were unaware when their patients had existing advanced directives.

The third annual National Health Care Decision Day will be April 16, 2010. On this day, you should be thinking about your end-of-life decisions. If you already have an advanced directive, then you should review it.

Even though discussions about death and dying are difficult, it is best to be addressed before an acute condition arises. It is important to make your decisions known to your family as well as your healthcare providers. Advanced directives allow healthcare professionals to carry out your final wishes and they are not a type of forced euthanasia.

We can utilize the National Health Care Decision Day to focus on this important issue and begin to reshape public opinion about advanced directives and their benefit to patients and their families.

My turn

Alison Kaneshiro, RN-BSN, formerly of Danville, is pursuing her master’s degree at the University of North Dakota in the Family Nurse Practitioner program. She has aging parents, in-laws, and a grandmother. She strongly believes that Advanced Directives and end-of-life planning will allow the proper care for them as well as anyone that enters the health care system.