The following is an article from the April 2017 issue of "Get Your Ducks in a Row" Carolina Family Estate Planning's free newsletter. You can read the rest of the issue, as well as back issues of our newsletter online at www.carolinafep.com/library/newsletters/ or subscribe for free at www.carolinafep.com/newsletter.cfm
In April 2017, we had a special presentation which sparked some additional thoughts about End-of-Life Planning. Audio and slides for the presentation are available at https://www.carolinafep.com/video/making-informed-end-of-life-decisions.cfm
As an estate planning and elder law firm, we discuss the topics of death and disability day-in and day-out. Fortunately, most often we’re just planning for the future possibility of disability or death, but sometimes, we find ourselves having difficult conversations with clients and their loved ones who are facing imminent end-of-life decisions. I don’t think any amount of advice, reading, etc. can fully prepare someone for having to go through end-of-life decisions first-hand, but there are certainly things that I have learned that I wish more people understood about the end-of-life process.
I recently joined a national group of elder law attorneys on a new “Death & Dying Project. About this challenging topic, I can’t feel anything but somber. But I am excited to be involved with a group of the best minds around, coming together to help people better understand the dying process. The reality is that many people are in the dark about what’s involved until they have a first-hand experience.
To that end, I recently read the book, Being Mortal: Medicine and What Matters in the End, by surgeon Atul Gawande. I had been given a copy of this back in 2014 after it first came out, but at the time I was reading something else, it got put on the bookshelf, and I forgot about it. I’m glad I picked it back up. Gawande is a gifted storyteller, and the book is an engaging read that I would highly recommend.
Additionally, over the past couple years, I’ve attended presentations from palliative care physicians and read numerous articles. While I would not consider myself an expert on the topic, I have learned some things along the way that I thought are worth sharing:
- Doctors are human, and are prone to unintentional biases. For example, Gawande noted that when doctors are asked how long a terminally ill patient has to live, they overestimate on average by a factor of five.
- Doctors are traditionally trained to solve problems, but many are not well-trained on what to do when there’s no cure to be had. As a result, they continue to focus on solving problems by prescribing an endless array of treatments, often with detrimental side-effects, in an effort to prolong life. What if instead, doctors started telling their patients how to live the best remaining life possible and talked to them about how to die? Modern medicine seems to exalt longevity over a life worth living.
- Aging well, whether at home or in an assisted living community or similar, is often bolstered when the senior feels a sense of purpose and independence. This might involve helping care for pets, volunteering, or activities as health permits.
- Doctors sometimes overlook some important questions. If your loved one is ill, ask them:
- What are you wanting to accomplish with your care?
- How can I help you with your goals for your care?
- How much are you willing to go through to have a chance of living longer?
- Hospice and palliative care do not mean giving up. Many families put off hospice and palliative care far too long because there is a perception that it is giving up and means stopping other treatments. Palliative care is specialized medical care focused on providing relief from symptoms, pain, and stress of the illness with the goal of improving quality of life for the patient and the family. Gawande cited a 2010 study in which half of a group of stage IV lung cancer patients were assigned palliative care specialists. “The result: those who saw a palliative care specialist stopped chemotherapy sooner, entered hospice far earlier, experienced less suffering at the end of their lives—and they lived longer.”
This topic can be overwhelming in many ways. To continue this conversation, our office is co-presenting a special seminar at the end of April: It's Your Life, Making Informed End-of-Life Decisions, with Cooper Linton from Transitions LifeCare.
Audio and slides for the presentation are available at https://www.carolinafep.com/video/making-informed-end-of-life-decisions.cfm