The question is not “Will you die?” The question is “When will you die and how?”
No one knows the answer to that latter question but that fact alone should not deter responsible adults from planning for the inevitable. And contrary to popular belief, particularly in minority communities, end-of-life preparation will not hasten your demise.
Every adult should routinely have a yearly physical examination. This important visit to the doctor involves not only the review of past medical and surgical histories, a complete check-up, a discussion regarding preventive testing recommendations, but also direct conversation about living wills (an advanced directive) and maybe even hospice, depending on your current health status.
A living will is defined as a written statement detailing a person’s desires regarding their medical treatment in situations in which they are no longer able to express informed consent. These documents are generally discussed with other family members, typed up and shared with the person’s healthcare provider. The living will guides the physician regarding your wishes as it relates to resuscitation, desired quality of life, and treatments you do not want to receive. Living will templates can easily be downloaded from the internet, or you can consult with an attorney who could prepare the documents for you.
An additional point to remember is that your health status is not static. It changes over time. Therefore, living wills change as well. Resuscitation may look quite differently when comparing a young, healthy person against a 90-year-old with multiple health problems.
As mentioned earlier, culture plays a huge part in advance directives. Research has shown that racial and ethnic minorities experience a lower quality of service and are less likely to receive routine medical procedures than are white Americans. Therefore, it is imperative that providers ensure patients that they will not be abandoned or receive substandard care if they elect to have an advanced directive.
Another taboo discussion within minority communities is hospice care. Hospice care focuses on the physical and spiritual needs of a terminally ill patient. This care also provides support for the family during this transitioning process. Eleven to 18 percent of families, however, report that they were referred to late.
Hospice is not just for patients with cancer. Congestive heart failure, chronic obstructive lung disease and dementia are all appropriate conditions for hospice care as well. In fact, those diseases account for 56 percent of hospice admissions.
There are many misconceptions about hospice. For instance, many people, including doctors, believe that you will be penalized if the patient lives past six months while on hospice. There is no longer a penalty for an incorrect prognosis if the disease runs its natural course. Another misconception is that a patient must be designated as “DNR,” do not resuscitate. The only requirement of hospice is that the patient is seeking palliative treatment only not curative. A third misconception of hospice care is that referrals can only come from physicians. Nurses, family members, social workers and essentially anyone can refer patients to hospice.
To sum up, healthcare should be viewed as a continuum. Newborn care, well-child visits, adult care and end-of-life care are all part of the process. Each stage requires preparation and should receive equal attention. End-of-life decisions can be difficult when made under duress. Don’t wait. Plan now for end of life.
Denise Hooks-Anderson, M.D., is assistant professor at SLUCare Family Medicine. Email yourhealthmatters@stlamerican.com.
