Living Wills and the Equality of Life

DN Wednesday, January 5, 2011: Discuss this question with your family or friends:


Return of the “Death Panel” Myth is a “Travesty,” Says Dr. Atul Gawande: Gawande talks about doctors having end-of-life discussions with patients:

“So, in La Crosse, Wisconsin, they had a community effort. And the result was, over 90 percent of the population ended up having what they call advanced directives, a living will. The doctors actually paid attention to what they had written down, which often gets ignored. And it was not a matter of follow what this piece of paper says. The power of it proved to be that for people with terminal illness, they had thought about what might happen as they got sicker, whether they wanted to be at home or in a hospital when the end came, how much control they wanted over their life.”

“And by being able to articulate their values and concerns about facing that kind of illness, two things happened in La Crosse. First of all, the number of people who died in intensive care units and being kept alive on ventilators and on machines, past the point of being even conscious of what’s going on, declined markedly. The costs of people in the last year of life went down markedly. There was no change in how long people lived in La Crosse, Wisconsin. And it really became a model community for the entire country. They were the ones. They said the one barrier we have left in La Crosse is that the doctors don’t have the time to talk to patients, because they’re only paid for a short visit. Having the time to talk at length to people who are really, really sick, facing a few months to live, they needed to be compensated for that. And that led—they were the starters of the very provision that could help people decide, do they want hospice care versus hospital care, and having the dollars in place to make those conversations less of a burden on the medical community.”

As a hospice volunteer, we were encouraged to discuss and form a living will, telling our loved ones what we wanted in terms of interventive treatments if we were unable to communicate. Do you think this is a good idea for people of all ages? Have you had this conversation with those close to you? Have you put it in writing? Should doctor offices give out living will forms?

Does fear of death drive our healthcare systems, rather than quality of life? Where does the equality of life figure into a for-profit healthcare industry, where intellectual property laws prevent developing countries from producing medicines?

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