Having “The Conversation” about End of Life Healthcare Planning

The Nugget, Sisters, Oregon – October 15, 2014

Having “The Conversation”

By Diane Goble

Ever since Ben Franklin warned us, “If you fail to plan, you are planning to fail,” we’ve been diligently planning for everything — college, career path, marriage, children, home buying, vacations, retirement — everything, that is except our inevitable end of life. We don’t want to think about that so we tend to ignore it or postpone dealing with it, often until it’s too late. We live in the state of denial that keeps us oblivious to the unthinkable fact that this day could be our last on earth.

Hopefully that’s not true for you this day, but statistically, in this country, 1 person dies every 3 seconds, approximately 6800 of us every day, 2,468,435 every year. Most people die from health-related conditions, including (in order) heart disease, cancer, chronic respiratory diseases (COPD) and stroke. Accidents are next down the list. All of these are, to some degree, preventable, treatable, manageable, mitigated by medical care and healthy lifestyle changes, and most of us will survive to live the life we planned to a ripe old age.

And that’s part of the problem. Health care has improved, we’re making progress with many cancers, we’ve recognized the problem of obesity and we’re eating healthier and exercising more so we’re living longer but we’re getting diseases now that people didn’t use to get because they died at earlier ages — Alzheimer’s Disease, in particular, but also emphysema, COPD, Parkinson’s Disease, and diabetes. And with the aging Boomer population, we wonder will there be rationing of medical services.

The health care system has us focused on treatments that almost kill us in order to make us better so we can live longer and get more diseases for them to treat. At the same time there are more people in need of care, there are also fewer doctors and medical services are stretched thin.

And within this maelstrom of activity is the elephant in the room. At some point, we are all going to die — but no one wants to admit it or talk about it and certainly know one wants to plan for it. We always think there will be more time.

This is a quote from this correspondent’s soon to be released book on amazon.com, Beyond the Veil: Our Journey Home, from a woman named Kathy who shared her experience of not planning ahead:

While we had gradually acknowledged to each other that he might not make it, we’d never really accepted it or talked about what it meant. I always thought we’d have a period of time when he was in hospice care when we would talk more and say our goodbyes. While I, and my kids, said lots of goodbyes and I love yous while he was in a coma, he was never able to communicate with us again. I still replay those last few days over and over and wonder how we didn’t know he was so close to the end and wonder if he knew.

There is a lesson in this: to say the things we want to say while we can – and it illustrates why it is so important to plan for the end of our lives, not just for our selves, but for our loved ones as well. We won’t know how we are going to die, where we will be when it happens, who will be with us or if we will be alone, but we can make our choices known about how we want to be treated at that crucial time, which will guide our loved ones to follow our wishes.

We do have some options and they are more likely to be honored if we have discussed them with our family members and doctors, appointed a healthcare representative who supports our wishes through our Advance Healthcare Directive so physicians will know what we want and don’t want if it comes down to that. The biggest hurdle is sitting down to have the conversation.

Realize that this is not a one-time conversation. It may occur in bits and pieces — a question at the dinner table, a comment during a TV program or news story, a shared article from a magazine, a book, a website, a post on Facebook. Over time and with new information or health concerns, you may change your mind several times.

You may have a conversation with your doctor or a clergy member that provides some new insight or clarifies your values. After seeing what another family went through, you may decide you do or don’t want that to happen to you. Visiting a friend in hospice care may change you mind about how soon you would want to bring hospice services into your life or the life of a family member. Advance Healthcare Directives are changeable and should be reviewed every 5 years or as you health changes.

No matter how old you are — and perhaps this is something everyone should do when they first get their driver’s license because those are extremely vulnerable years for accidents — no matter what your health status is, the time to have these important conversations is when you are healthy and mentally competent to make decisions. By the time you are in an ambulance, in the ER, or on your deathbed, it is too late. Leaving it to your distraught family members to decide what you would want during dire circumstances is setting them up for unending grief and trauma over whether they did they right thing — no matter what they did or didn’t do.

Fortunately, right here in Sisters, there are several people, including Kelsey Collins, Sue Stafford, myself and others, who are available to help people sort through the information about Medicare, home health care, palliative care, hospice services, Advance Healthcare Directives, POLST and Oregon’s Death with Dignity Act. Talk to your doctor, talk to your spiritual adviser and by all means, talk with your family about your last wishes — then you don’t have to think about it anymore!

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