Special Senate Committee Talks Advance Care Planning

Special Senate Committee Talks Advance Care Planning

Posted on Friday, May 23rd, 2014 at 9:27 am by lifemediamatters

Jennie Chin Hansen, C.E.O. of the American Geriatrics Society

Jennie Chin Hansen, C.E.O. of the American Geriatrics Society, moderated the roundtable meeting

During a roundtable meeting hosted by the U.S. Senate Special Committee on Aging, industry leaders called for an increased role among care providers to help more Americans complete their advance health care directives.

An advance directive may take many forms, such as a living will or power of attorney for health care. They help ensure one’s end of life wishes are carried out in the event a patient is unable to communicate. However, the vast majority of Americans have not planned for the end of life, according to recent findings published in The American Journal of Preventative Medicine.

“For frail elders, advance care planning for care preferences is particularly important and ensures that families, the physician, and other health care team members understand and act in accordance with a person’s wishes when it comes to the type of care that he or she would like to receive,” offered moderator Jennie Chin Hansen, C.E.O. of the American Geriatrics Society. “National and state policies should encourage patients and those who care for them to engage in advance care planning discussions.”

Paul D. Malley, president of advocacy group Aging with Dignity, said he urges both haste and caution as more providers help their patients plan in light of the Affordable Care Act.

“We must act with haste, because American families can’t wait. They need help navigating the system and navigating the expression of their wishes,” he said. “Caution, because I think as the best health care systems are working to improve care at end of life, there may be a focus on systems and processes that don’t make room for the individual preferences.”

Although the shift towards electronic medical records may help some physicians and care providers better learn their patients’ wishes, Malley said he believes there is still no replacement for the role of loved ones in end of life decision-making. “It is important to understand our roles, and our respective biases,” he said. Aging with Dignity distributes the popular Five Wishes collection.

Daniel OBrien, senior vice president of Ethics, Discernment and Church Relations with Ascension Health, offered a Roman Catholic perspective.

O’Brien said he believes comfort and care for the dying should be a primary goal of health care. “Palliative care, in particular, is one specific approach to care for patients with serious illness that we must support and grow, because it focuses on caring for the patient as person, regardless of diagnosis,” he said. “It focuses on identifying and addressing the goals of care that are meaningful to them.”

Ascension, the nation’s largest Catholic health system, has been working with the Florida Conference of Bishops’ Committee for End of Life Care on a POLST (Physicians Orders for Life Sustaining Treatment) form modified to address concerns under Church teachings.

“Bishops in some states have opposed POLST legislation outright, mostly due to specific problematic features of the POLST paradigms in those states,” O’Brien said. “After making recommendations to add a few additional protections to the form, the majority of the committee recommended to the Bishops’ Conference that we allow piloting of our edited POLST in our Catholic hospitals.”

POLST forms are medical orders, and are more detailed than conventional living wills or advance directives. They allow patients to indicate preferences regarding resuscitation, intubation, intravenous antibiotics and feeding tubes. The forms are intended for patients in their last year of life, and they can follow patients across care settings. More than a dozen states have officially endorsed versions of the POLST form.

The Senate Special Committee on Aging was first established in 1961 as a temporary committee, but was granted permanent status in 1977. Although the committee has no legislative authority, it studies issues and investigates reports of health fraud and abuse. Sen. Susan Collins, D-Maine, is a ranking member.

Resuscitation Efforts Death Ritual In Western Medicine

Posted on Wednesday, May 29th, 2013 at 11:19 am by Life Matters Media


Although palliative care and hospice service have improved the death experience for many Americans, demands for non-beneficial resuscitation efforts are still frequent, said neonatologist Kelly Stuart at the Second Annual Conference on Religion and Medicine in Chicago Tuesday.

Medicalizing the death experience promotes dualism, Stuart said, separating both body and soul and death ritual and medicine. She said dualism does not attend to the needs of the whole person.

Dualism is more common in the Protestant traditions, because Protestants are largely without rituals. The rituals have been lost since the Reformation and the growth of organized medicine. Rituals become funeral services, usually without prayers for the dead.

“Race has been a disparity in the marketplace, so being black is a negative indicator for advance directives,” Stuart said. Due to a long history of receiving less care than whites, many blacks opt for more aggressive treatments at the end of life.

Blacks are almost twice as likely than others to choose aggressive end of life treatments and decline do-not-resuscitate orders, according to a recent study by the American Journal of Critical Care.

“Predominately Protestant, there is also comfort in redemptive suffering for the black community,” Stuart said.  Thus, many insist everything medically possible be done at the end of life- giving them they care they wanted all along. Resuscitation becomes a sort of death ritual for blacks and other Protestants, almost a Christ-like experience.

The adult children of terminally ill patients often spend months fighting with insurance companies and hospitals for their parents’ medical treatment. Once treatment begins, it can feel like giving up to elect hospice or palliative care.

Only 7.5 percent of hospice patients are black- that is less than half of their population representation in the United States, The Washington Post’s Rob Stein reported in a 2007 article.

Stuart urged reform, because aggressive treatments can lead to more painful deaths. “The American death experience lacks positive ritual, and non-beneficial resuscitation has substituted for death ritual,” she said. The medical community participates in the distortion. She urged families to remove the conversation about the subject from hospitals, and instead speak of it within the context of a family’s faith.

Stuart said she finds it helpful to speak with chaplains about suggestions for non-beneficial resuscitation. “One woman told me I wanted her son to die because he was black, it really offended me. It took me a long time to get over, but you have to come with open hands and build trust,” Stuart said.

POLST Form Presented At Northwestern Memorial

Posted on Thursday, May 2nd, 2013 at 3:12 pm by Life Matters Media

Image: Mulcahy speaking to a group of physicians at Northwestern Memorial Hospital

Image: Mulcahy speaking to a group of physicians at Northwestern Memorial Hospital

“The Illinois POLST form is a step in the right direction,” said Mary F. Mulcahy, a co-founder of Life Matters Media and practicing oncologist at Northwestern University, while lecturing physicians about the form Thursday at Northwestern Memorial Hospital.

In March, the Illinois POLST form was released to the public, an effort headed by the POLST Paradigm and the Chicago End-of-Life Care Coalition. This update to the Illinois DNR advance directive aims to improve the quality of life for patients at end of life.

POLSTs, Physicians Orders for Life Sustaining Treatment, are more detailed than conventional living wills and advance directives. These forms give patients the freedom to indicate preferences regarding resuscitation, intubation, intravenous antibiotics and feeding tubes. Such forms are intended for patients in their last year of life, and they can follow patients across state care settings and direct doctors to provide or withhold lifesaving treatments.

Image: POLST form

Image: POLST form

The form should be adjusted over time to fit each patient’s prognosis. “This is not a one-time thing, as patients progress the form can change,” Mulcahy said. “There should be shared decision-making between physicians and patients.” To be valid, the form must be signed by the attending physician.

In the U.S., the average patient visits the hospital more than 30 times and meets nine different physicians during the last six months of life. These patients could benefit from having their medical wishes written down and on hand; the convenience helps cut through the chaos and confusion prevalent in care settings.

POLST was developed in Oregon in the 1990s, and now 14 states have POLST programs. Twenty-eight states are considering the use of such forms.

“Hopefully this form will change the culture and get people talking and preparing for the end of life,” Mulcahy said.

Palliative care expert Andrew Thurston, M.D., agreed. “I think this is great. My hope for the POLST form is that it will clarify patients’ wishes for their end of life care, and that it helps doctors more effectively communicate with their patients,” said Thurston. “We need more open discussion, and with easier language, this form helps.”

Death Denying Culture Unfortunate Result Of Medical Innovation

Posted on Wednesday, April 17th, 2013 at 9:51 am by Life Matters Media

Advances in medical therapies and technological innovation have led to a “death denying” culture pervading American health care, said Dr. Susie White, an emergency medicine physician at Provena St. Joseph Hospital, during a bioethics symposium at the University of Illinois-Chicago on National Health Care Decisions Day.

National Health Care Decisions Day aims to inspire and educate the public and medical providers about the importance of advance care planning.

White speaking to a room of medical providers, caregivers at symposium on NHCD Day

White speaking to a room of medical providers, caregivers at symposium on NHCD Day

“Many older patients find themselves in a position they never thought they would find themselves in,” White said. “We have gained 30 years in our life expectancy.” Prior to antibiotics and modern therapies, most people died quickly- from infections, malnutrition or fevers.

Now, only 10 percent of Americans die sudden, unexpected deaths, and the sick and dying receive care in hospitals.

These shifts have fueled a “death denying” culture, one in which many wish to suppress or avoid any sign of aging or illness, White said. Families may grow angry at doctors- or even the patient- when treatments fail.

White maintains that palliative care can help patients and their families, and that the relatively recent medical specialty has the potential to reverse this culture of denial. “What we want to do is form a team of doctors, nurses, chaplains, anyone who might be helpful in an individual’s case and help anyone who has a life- limiting disease,” she said. “We want everyone in the family on the same page and smooth transitions.”

Most patients should not begin palliative care during the process of active dying, but rather, much earlier- even at the onset of illness, White said. “Palliative care is not hospice, but is an extra layer of support, that can go along with aggressive treatments,” she said.

The Integritas Institute for Ethics, a program of the John Paul II Newman Center, arranged the symposium, which explored the ethical challenges that arise at the end of life.

Five Wishes: One Of America’s Most Popular Advance Directives

Posted on Sunday, March 10th, 2013 at 6:41 am by Life Matters Media

Launched in 2011 by the nonprofit Aging with Dignity, Five Wishes Online has become one of America’s most popular living wills.

For a $5.00 fee, the Web site lets adults choose who they want to make medical decisions on their behalf if unable to do so, preferences for medical treatments, comfort care and social interaction.

Written with help from the American Bar Association’s Commission on Law and Aging, the form meets legal requirements in 42 states and can be used in all 50. It can be printed immediately or emailed to physicians.

With help from the United Health Foundation, the form is available in 26 languages, including Spanish, Hebrew and traditional Chinese. The less computer savvy can print out the form and fill it in by hand. There are even video tutorials and easy to navigate prompts.

First introduced in physical form in 1997, more than 18 million copies are now in circulation. It boasts easy to read language and simple explanations for those unfamiliar with medical and legal terminology.

“Aging with Dignity believes we have responsibility in our society, local communities and families to care for the most vulnerable among us – those who are sick, aged, weak, disabled, poor and isolated,” an online statement reads.

Massachusetts’ lawyers, doctors, hospices and faith communities have been providing the form because it has proven successful, the North Andover Patch reports.

Five Wishes Online is just one of a growing group of Web sites offering advice and resources for those making end of life decisions. LMM previously reported on the popularity of Prepare and The Conversation Project.