End-of-life Decisions


Health Reform: Unfounded Fears Of Government-sponsored 'Euthanasia' Obscure The Real Need For Planning Ahead

August 09, 2009|By EILEEN AMBROSE

As an example of how opponents of health care reform have been able to twist facts to scare older Americans, look no further than a comment made to President Barack Obama during a recent town hall meeting.

Mary of North Carolina told the president she was worried about rumors she's heard about health care legislation. "I have been told there is a policy in there that everyone that's Medicare age will be visited and told to decide how they wish to die," Mary said. "This bothers me greatly."

Who wouldn't be freaked out by that? Or by some of the other wild claims of government-backed euthanasia.

But that's not what's proposed at all. Fears are being stoked over a provision that would have Medicare pay for a visit to the doctor if older Americans want to talk to a physician about end-of-life care, including setting up a living will. This is the document that spells out what sort of care you want if your health fails to the point where you can't speak for yourself. It's a document all adults - even healthy ones in their 20s and 30s - should have.

Proposed legislation calls for Medicare to foot the bill for a consultation with a doctor once every five years, or more often if a patient's health significantly declines. That's it. No one would be required to talk to a doctor or set up a living will.

The president explained this to Mary, noting that he and his wife have a living will as did his late grandmother. But he also added that this is just a proposal, and if it bothers people so much, Congress could drop the provision in the final bill.

That would be a shame. It would mean that fearmongers have succeeded in stripping away a small, but valuable perk for older Americans on fixed incomes.

Yet no matter what happens with health care reform, adults need documents that address their end-of-life wishes so loved ones aren't left to guess.

"It is the responsible thing to do," says Howard Sollins, a health care attorney in Baltimore. "If you care about others, why wouldn't you want to give them some guidance so they aren't completely without information about what you want?"

The health care legislation focuses on living wills for Medicare beneficiaries age 65 and older. But it's just as important for young adults to have such documents, says Julie Heffner, a social work supervisor at Gilchrist Hospice Care in Hunt Valley.

Young adults are less likely to have had end-of-life care conversations, she says, so families might have to guess the wishes of someone who is incapacitated after an illness or accident.

Indeed, patients stricken in their 20s have been at the center of high-profile right-to-die cases where relatives feud in court about whether to stop treatment. That includes Terri Schiavo, Karen Ann Quinlan, Nancy Cruzan and Ronald W. Mack, a Marylander whose case led to state legislation in the early 1990s.

State law governs living wills. In Maryland, end-of-life health care documents are rolled into what's called an "advance directive." It has two parts: naming a health care agent and the living will.

You don't need a lawyer to set one up. The Maryland's attorney general's office posts forms online at www.oag.state.md.us that you can print out and fill in. You can fill out one or both parts, or add your own supplement.

Here are things to consider:

Health care agent : The directive allows you to name a person to make health care decisions on your behalf when you no longer can. Choose someone you trust, who knows your wishes and will honor them.

If you don't name an agent and become incapacitated, a surrogate will be appointed based on state law, starting with a guardian, then spouse or domestic partner, followed by adult children, parents, adult siblings and so on, says Paul Ballard, counsel for health decisions policy with the Maryland attorney general's office.

Designating an agent in an advance directive is important if you want someone other than a family member in this role, Heffner says.

Name a single agent - not multiple co-agents who might not agree. But make sure you name one or more backups in case your first choice can't serve as your agent.

Living will : This second part of Maryland's advance directive allows you to express your medical wishes if you are in a persistent vegetative state, a terminal condition where death is imminent or at an end-stage condition where there's no hope for recovery but you can linger for months or years, Ballard says.

"It's important to be specific in the advance directive to what you want. Vague language can create problems," he says.

Doctors can't override your directive unless the treatment you request is "medically ineffective," Ballard says.

Giving guidance : Your directive can state when you want it to kick in, such as after the doctor says you have permanently lost the ability to make decisions.

You also can state whether you want your agent to follow your wishes to the letter, or to, say, use his or her best judgment after reading the directive.

Witnesses : In Maryland, you need two people to witness your signing of the advance directive. It can't be just any two people, though. The health care agent can't be a witness. And one of the two witnesses can't knowingly inherit anything from you or financially gain from your death.

Your directive won't be legally binding if you fail to get it properly witnessed, Ballard warns.

Copies : Once the advance directive is completed, give copies to those who need to know your end-of-life wishes, such as your doctor, health care agent and family.

An advance directive doesn't expire. Periodically review it and update the document if, say, your choice of a health care agent or your view on end-of-life care has changed.

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