Tag: advance directives

Blog Posts (8)

July 15, 2015

Medicare Considers the Value of Advance Care Planning

<p><span style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;">Last week the Centers for Medicaid and Medicare <a href="http://www.huffingtonpost.com/2015/07/08/medicare-end-of-life-counseling_n_7757036.html">announced a proposal</a> that would provide Medicare reimbursement for providers to spend time with patients discussing advance care planning. </span><span style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;">Though some have argued that this process will carry an inherent bias toward non-treatment, the purpose of such conversations is to seek direction from patients about preferences, values, and expectations should they lose the ability to <a href="http://www.nytimes.com/2015/07/09/health/medicare-proposes-paying-doctors-for-end-of-life-counseling.html?_r=2">express these things for themselves</a>.</span><span style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;"> While many persons who articulate their treatment preferences indicate the desire to forego aggressive intervention, this is hardly unanimous. There are plenty of folks who want all possible treatment offered to sustain life. The point of having discussions with healthcare providers is to determine what any given individual prefers.</span></p> <p class="MsoNormal" style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;"><span style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;">Acute care providers have long been left with challenging dilemmas when patients are unable to communicate their healthcare goals, and the default is to treat and often treat aggressively. When a patient arrives to an acute care setting with documentation of preferences for treatment, interventions and goals can be set based on the individual’s prior wishes – whether this is to sustain life using any possible technology, or to allow a natural, uninterrupted dying process. The default of treating when there is any doubt will not change, but the opportunities for patients to discuss and document their own preferences will be enhanced with this legislative support. Providing muscle in the form of funding for these important conversations will only encourage more of a good thing. </span></p> <p><span style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 19.0400009155273px;"><strong>The Alden March Bioethics Institute offers a Master of Science in Bioethics, a</strong> </span><strong style="line-height: 19.0400009155273px; color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px;">Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our <a style="color: #000099; text-decoration: underline;" href="/Academic/bioethics/index.cfm">website</a>.</strong></p>
July 13, 2015

Do Physicians Follow the Golden Rule? Some Thoughts on End of Life Care

<p class="MsoNormal" style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;">There has been a <a href="http://www.nap.edu/openbook.php?record_id=18748">lot of talk recently</a> about end of life care and how people die in America as well as important recommendations made on how effective end of life care should be provided. But there is still much work to be done. Because the nature of this work cannot be resolved by more laboratory experimentation or investment in and mastery of technology, the kind of challenge presented to our healthcare system is actually more daunting, since it relates to how physicians’ communicate with their patients. The precise question I am raising with respect to the kind of end of life care patients receive at the end of their lives is this: Do physicians follow the golden rule? Do they give their patients the chance to have the same kind death they would want for themselves and for their families? Sadly, the answer is too often, no, they often do not follow the golden rule.</p> <p class="MsoNormal" style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;"><span style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;">A recent study from Stanford University “found most physicians surveyed would choose a do-not-resuscitate or “no code” status for themselves if they were terminally ill even though they tend to pursue aggressive, life-prolonging treatment for patients facing the same prognosis.” At the same time, at 2013 JAMA study found that most seniors want to die at home or in the home of someone they know and avoid burdensome end of life treatments, yet only about 1 in 3, or less, actually do. In fact, about 1 in 3 people over 65 die still die in hospitals or ICU’s after having receiving aggressive, often burdensome, medical interventions. Of those that are moved to hospice care, 1 in 3 are there for less than three days before dying. So it’s safe to say that, though end of life care has improved for the past three decades, there are still many elderly people receiving overly aggressive, sometimes unwanted treatments, at the end of life. What are the barriers to elderly patients receiving the kind of end of life care they say they want? Let me go over two obvious ones.</span></p> <p><strong style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 19.0400009155273px;">The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our <a style="color: #000099; text-decoration: underline;" href="http://www.amc.edu/Academic/bioethics/index.cfm">website</a>.</strong></p>
May 21, 2014

National Healthcare Decisions Day: The Need to Reach New Audiences

<p>The seventh annual <a href="http://www.nhdd.org/">National Healthcare Decisions Day</a> (NHDD) was held on April 16<sup>th</sup> of this year, and events at national, state and local levels were held to educate people about the importance of advance care planning and encourage participants to complete advance directives. Providing resources and information that drives home the message about how important it is to let others know one’s preferences for healthcare and end of life care is intended to promote conversation and documentation of these wishes which are then implemented when the individual is no longer able to express preferences for themselves. But does it do enough to generate interest in those who prefer to avoid such unpleasantries?</p> <p class="MsoNormal">Repeated studies show that advance directive completion rates are low in the US. People simply do not like to talk about end of life, and it is not clear that the NHDD, however well intended, is making the topic any more palatable. Designating a day to recognize the importance of advance directives is an important start, and the materials are often excellent. <a href="https://www.agingwithdignity.org/five-wishes.php">Five wishes</a>, for example, gives a carefully crafted set of questions to help people thoughtfully consider what matters most to them when it comes to medical intervention, particularly in the end of life context. Still, this only works if people come to the table for the conversation.</p> <p class="MsoNormal"><strong style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 20px;">The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our <a style="text-decoration: underline; color: #000099;" href="/Academic/bioethics/index.cfm">website</a>.</strong></p>
April 21, 2014

Senator Advances Bill To Pay Medicare Beneficiaries to Register Advance Directives

by Craig Klugman, Ph.D.

U.S. Senators Tom Coburn (R-OK) along with Senators Christopher Coons (D-DE) and Richard Blumenthal (D-CT) introduced a bill to the U.S.…

March 9, 2014

How LaCrosse Wisconsin sets a new example when it comes to Advance Directives

<p>As a clinical ethicist, many of the requests for assistance that come my way have to do with advance directives, either the lack of any documented wishes, incomplete or unfamiliar forms, or otherwise confusing messages about what a patient truly wants when it comes to life sustaining medical treatment. Too often, my help is needed when the patient is no longer able to tell others what he or she wants and does not want. On one such call, a group of compassionate nurses and I sifted through a charts to see what we could learn about a particular patient’s known wishes. In the course of our conversation, a nurse asked me if I had heard about LaCrosse, Wisconsin where 98% of the town’s population has advance directives. After giving me a quick summary between her own patient charting, delivering meds, and coordinating a pending admission, she printed the article. For anyone who missed it (like me) the link is here: <a href="http://www.npr.org/blogs/money/2014/03/05/286126451/living-wills-are-the-talk-of-the-town-in-la-crosse-wis">LaCrosse Wisconsin on NPR</a>.</p> <p><strong style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 20px;">The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our <a style="text-decoration: underline; color: #000099;" href="/Academic/bioethics/index.cfm">website</a>.</strong></p>
March 4, 2014

End-of-Life Planning, Roz Chast Edition

Please, please go read this wonderful and moving and honest cartoon about, among other things, why we don't do end-of-life planning, by longtime and beloved New Yorker cartoonist Roz Chast. Really, go read it. 
February 18, 2014

Euthanasia in Quebec?

Quebec legislators are reportedly within days of passing a law that would permit euthanasia for competent adult patients with incurable disease which causes constant and unbearable physical or mental suffering. The euthanasia-related portion of Bi...
June 13, 2012

"The Descendants": The Bioethics Movie That Wasn't

Okay, I am probably one of the last people in the United States (no, probably the world) to watch the movie “The Descendants”.…

News (2)

June 18, 2012 6:43 pm

Mapping Your End-of-Life Choices (New York Times)

What he would not want is to be on a ventilator indefinitely, or to have his heart restarted if he had a terminal illness or would end up mentally impaired. Nuances like these, unfortunately, escape the attention of a vast majority of people who have completed advance directives, and may also discourage others from creating directives in the first place. Enter two doctors and a nurse who are acutely aware of the limitations of most such directives. In 2008, they created a service to help people through the process, no matter what their end-of-life choices may be.

February 27, 2012 1:02 pm

76% of patients neglect end-of-life care planning (American Medical News)

More than 80% of patients believe it is important to have their end-of-life wishes in writing, yet less than a quarter of them have accomplished that planning, said a survey of nearly 1,700 California adults released in February. #bioethics #endoflife