Category Archives: End of Life

This compelling story in today’s Washington Post (washingtonpost.com) is about a physician having a conversation with his physician father, age 88. Here’s an excerpt:

“We were discussing treatment options promoted by his primary-care physician and other doctors for an aortic aneurysm… He turned to me and asked, ‘Why would I want to fix something that is going to carry me away the way I want to go?’ … With his unexpected question, he directly challenged the assumption that a doctor’s advice is always in a patient’s best interest, particularly regarding a medical problem late in life. … Furthermore, Dad was making an important distinction, between care at the end of life (in this case, palliative care for pain) and treatment (aneurysm repair). He was also suggesting a natural exit strategy.”

Here’s a link to the full article:

https://www.washingtonpost.com/national/health-science/mission-creep-doesnt-benefit-patients-at-the-end-of-life/2016/08/22/3664630c-032e-11e6-9203-7b8670959b88_story.html

Health & Science
Mission creep doesn’t benefit patients at the end of life
By Samuel Harrington
The Washington Post
August 22, 2016

Robin

This article, in Kaiser Health News (a news arm of the Kaiser Family Foundation), the author notes that most Medicare recipients and most Californians with Medi-Cal do not know that they are now eligible for a new health care benefit: “advance care planning” discussions with doctors. Such discussions can include those whom you want to speak for you if you are incapacitated and what your medical wishes are.

Medicare recipients can have an unlimited number of conversations with their doctor.  Medi-Cal recipients can have this conversation twice a year with their doctor.  Other insurance plans may cover these discussions.

The executive director of the California State University Institute for Palliative Care believes that anyone over 18 should have this discussion with their physician and should complete an advance care directive.

Amazingly, I’m helping a local family today with brain donation where the intended brain donor (who has Lewy body dementia and lives in a care facility) has NOT identified a healthcare power-of-attorney nor has she completed an advance care directive. At minimum, I believe we should all have a document identifying our healthcare agent.

The Institute for Palliative Care director recommends the “Five Wishes” form, which I recommend as well. We have completed this form within our family. See fivewishes.org.

There are lots of other California-specific resources online as well for completing an advance care directive or a healthcare power-of-attorney document.

See: khn.org/news/advance-planning-for-your-end-of-life-care/

Ask Emily
Advance Planning For Your End-Of-Life Care
Kaiser Health News
By Emily Bazar
July 7, 2016

Robin

Yesterday, I received this email from long-time local support group member Denise Dagan.  She’s referring to an article in “The Week,” which is an excerpt from a longer article in the January 2016 issue of “Harper’s Magazine.”  The articles are about a medical oncologist’s use of the Dying with Dignity law in Oregon.  Then the oncologist is diagnosed with cancer.  Denise says that despite a couple of errors, the excerpt is “a well written reminder that we should all think about what is important to us when it comes to end of life care and/or treatment.”

In her email, Denise also discusses for-profit hospice and non-profit hospice, plus Dr. Gawande’s book “Being Mortal.”

Thanks to Denise for sharing!

Robin

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From Denise Dagan:

The Week magazine has a nice excerpt from a Harper’s Magazine article about an oncologist using Oregon’s dying with dignity legislation.  It doesn’t mention palliative care; and it should.  [Perhaps the full length article does.]  It also implies, in the second paragraph, that you can’t die at home if you are enrolled in hospice care, which is patently false.  Otherwise, it’s a well written reminder that we should all think about what is important to us when it comes to end of life care and/or treatment.

A more fully explored text on this topic is Being Mortal: Medicine and What Matters in the End, by Atul Gawande.  The first half of the book mostly explores the evolution of housing and assisted living options for seniors and the disabled.  The second half follows the author’s father’s end of life experience.  The upshot is the author’s personal growth as a physician in helping patients understand the medical options available to them and navigate their own end-of-life path.  He is a huge proponent of palliative and hospice care, and has some remarkable statistics from the insurance companies which support palliative and hospice care universal availability.  He believes every physician should be better educated in explaining the benefits of these services to their patients.

Personally, I think many people don’t realize some of the hospice services are for-profit businesses.  Articles like this one from CBS Money Watch discusses the pros & cons of for-profit and non-profit services.

www.cbsnews.com/news/the-big-and-profitable-business-of-dying/

Principally, for-profits market themselves toward long-term care patients, like those with dementia, so they can bill MediCare longer.  Since their focus is money, they may provide more limited visits and actual services with staff who have less training than Non-profits, which don’t do much marketing, take all patients, and tend to provide longer visits with more qualified staff.  Actual studies have not shown significant difference between profit and non-profit hospice care, as found in this abstract from the NIH:

www.ncbi.nlm.nih.gov/pubmed/22527254

Here’s a link to the full article in Harper’s Magazine from January, 2016:

harpers.org/archive/2016/01/when-i-die/

Here is the link to excerpt in The Week:

theweek.com/articles/600582/doctor-helped-dying-end-lives-dignity-diagnosed-cancer