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A Better Partnership

Publications

Apr 2015
15
April 15, 2015

Doctor's Bestselling Book Calls for a New Approach to End-of-Life Care


My extended family draws names for our present exchange at Christmas. Last Christmas, I drew my dad’s name. On the way to my parent’s house on Christmas Eve, I stopped at a bookstore to buy my dad’s gift. With a minivan full of kids eager to get to grandpa and grandma’s house, I knew an extended search would end in trouble, so I picked the first book I had heard good things about – Being Mortal. Pleased to have finished my Christmas shopping in record time, I didn’t give much thought to what this book was about.

Atul Gawande, the book’s author, is a surgeon and also a writer for the New Yorker. In Being Mortal, Gawande explores – from a personal and medical perspective – the reality that we age, become frail and often lose our independence. If the goal is to live life well, and with a purpose, how do we best respond when our bodies become weak or when illness strikes?

Gawande argues that the treatment-at-all-costs model, the model that prevails in emergency rooms and hospitals throughout this county, needs to be re-examined. The prevailing model too often results not in a better life, but in undue suffering, extended hospitalization and sometimes a shortened life. Yet we know, and Gawande acknowledges, these are knotty issues, because we do not want to make the mistake of shortening valued life when treatments may be successful.

It is encouraging that members of the medical field are engaging in this re-examination of the prevailing model and openly discussing what medical professionals want for themselves, their families and their patients. And we, as patients or potential patients, and families of patients and potential patients, need to examine and discuss these issues, too.

These discussions are happening with attorneys like me, in hospitals and in nonprofit community organizations, such as Making Choices Michigan. Through these conversations, more people are formulating advanced care directives and signing patient advocate designations. Even more people should: according to a 2013 Pew Research Center Poll, only 35 percent of adults nationally have such documentation in place. It is important for every person age 18 or older to have this conversation and sign these documents.

Still, having the conversation with an attorney, hospital worker or volunteer and signing patient advocate designations is not enough. If your spouse, your children or trusted friends do not know your care wishes, and if end-of-life decisions must be made, too often the treatment-at-all-costs system takes over, even if a patient advocate designation document is in place.

What can you do to prevent the treatment-at-all-costs approach to your end of life care? Here are some tips:
  • Share copies of your advanced directive and patient advocate documents with your primary care doctor (although your primary care doctor is not likely to be the doctor who will treat you in the hospital or emergency room.)
  • Upload your advanced directive and patient advocate document to the Great Lakes Health Connect website (gl-hc.org), which is secure. This allows hospitals (and only hospitals) to review your documents. West Michigan emergency room doctors and nurses are now beginning to check this site when someone arrives at the emergency room, and we hope that they will do so more often in the future. This is important because E.R. doctors and nurses often do not have time to review your entire medical file before treatment decisions are made. Warner Norcross & Judd can assist in uploading your patient advocate designation document onto this site if you would like.
  • Finally, talk with your family, close friends and advocate about your wishes. Even with an advanced directive and patient advocate designation in your medical file and uploaded onto the Great Lakes Health Connect database site, what family members tell your health care providers is given great weight, regardless of what your documents say. You need to express your desires to those closest to you.
These discussions are often the hardest part, but I encourage you to bring up the topic. Or, when others bring the topic up, pay attention, give that person time and listen. If the topic is difficult to discuss or you don’t know where to begin, I can recommend a good book on the issue. I’ll let you decide whether it is an appropriate holiday or birthday gift, but now that my parents and I have read Being Mortal, we will soon be discussing the book and its worthy topic. 

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