Help me to understand the fuss people are making about Durable Powers of Attorney for Health Care. I am puzzled by the assumption made by many that the proposed changes in Medicare will result in “pulling the plug on Granny.” I am horrified at the thought of a patient being too frightened to
talk to his or her physician about end-of-life care. I am certainly unclear about where the thinking came from that this conversation with your physician results in withholding treatment and the creation of “death panels.” Likewise, I am shocked when a physician is uncomfortable, and therefore avoids talking to patients and families about care at the end of life.
I learned early in my hospice career that as a hospice social worker/counselor, communication was my tool. I had no stethoscope, medicines, baths or any physical comfort interventions to do my job. Talking was my game, uncomfortable conversation was my challenge.
Asking patients and families, “Do you have a Durable Power of Attorney for Health Care? Who is it?” often led to the very conversation that people feared. Those who had them could talk more subjectively, reiterating the circumstances of the experience. Those who did not have the document were more confused and emotional. “I don’t know which of my children to ask?” “My doctor hasn’t said anything about it.” “I’ll talk to my lawyer.” “I have a will, isn’t that enough?” “Whatever my family wants is OK with me.” Statements often followed by stifled or free-flowing tears.
The introduction of Durable Powers of Attorney for Health Care began in the 1960s to ‘70s when people wanted to have more control over their medical care. Medical technology was advancing rapidly; life-sustaining treatments were increasing. And … studies underscored that the Baby Boomer generation, faced with caring for their aging parents, had become aware of the need to make plans for their future medical treatment.
Adults must overcome a kind of magical thinking, i.e. if I do not talk about it, it won’t happen. Death is an every man event; it happens to everyone.
Executing Durable Powers of Attorney for Health Care will, hopefully, help protect your right to make your own medical decisions, including the right to accept or refuse treatments. The intent of the document is to honor each patient’s personal values and definition of quality of life. And … hope is reinforced through communication. By sharing your wishes with your family, you hope to receive assurances that they will support your choices. By sharing your wishes with your chosen agent, you hope he or she will be able to implement them. By sharing your wishes with your physician you hope he or she will provide you and your family with the best choices in symptom management to maintain your expressed quality of life.
Physicians must be part of the conversation. After all, they will be responsible, along with your chosen agent, to implement your wishes. I think most of us prefer to not be a burden to the people we love, when we age. Ergo, advanced planning for our own end-of-life care is an individual responsibility. As difficult as the conversation may be, it is so worth having. To have some control over our own finality is a gift. Ultimately, I believe this process removes the helplessness we feel. Death takes care of itself; our responsibility is life.
— Gail Rink is the former executive director of Hospice of Santa Barbara.