We typically spend more time planning our summer vacations than we do planning for our inevitable journey from life.
Mapping that getaway to Maui is inarguably more fun than contemplating your own mortality. But failing to prepare for life’s final destination is like taking a trip without booking reservations — you’re likely to wind up in a situation not of your choosing.
More than 70 percent of us say we’d like to spend our last days at home, surrounded by people we know and love — and who love us. Ironically, 70 percent of us end up dying in a hospital, nursing home or long-term care facility, according to the Centers for Disease Control and Prevention.
Meanwhile, vital statistics also show that 100 percent of us will eventually die.
In an era when we’re held more accountable for our health care, and when many of us will be living into our 80s and 90s with illnesses that historically would have caused our early demise, it’s time to dissolve the cultural taboos that keep us from talking about dying.
It’s said that death and taxes are the only certainties of life. Just before mid-April’s Tax Day, we have National Healthcare Decisions Day on April 16. National Healthcare Decisions Day offers an opportunity to have conversations with loved ones about our values, preferences and priorities when it comes to our care through the end of life.
That’s why Providence in Southwest Washington is hosting a free community Advanced Care Planning event April 18, 6-8 p.m. at St. Martin’s University. For more information or to register, go to www.provregister.org.
That conversation typically begins with a reflection on what matters most and results in filling out an advance directive. An advance directive is a legal document that allows you to appoint someone as your health care agent in the event you become unable to speak for yourself, and conveys your values and wishes that person to consider in working with your doctors to make treatment decisions on your behalf.
The best way to support one another and protect your family from conflict and having to deal with ethics committees or a court is to make it clear — in writing — who has authority to speak for you if you become incapacitated.
You scan a copy of your signed advance directive to share with the person you chose to be your health care agent, other trusted family members and friends, and, of course, your doctor.
Evidence suggests that early palliative care — which typically includes conversations about people’s values and preferences and whether they have advance directives — when delivered concurrently with usual medical treatments, improves care quality, patient satisfaction, symptom management and quality of life. Yes we can afford it. Indeed, palliative care has been shown to reduce hospital costs and overall health care spending – mostly by providing alternatives to unwanted treatments. Most remarkably, concurrent palliative care can even prolong survival.
A growing catalog of such findings is moving the needle on policy. Last year, the Centers for Medicare and Medicaid Services began reimbursing health care providers for conversations with Medicare patients about their wishes for end-of-life care. We hope this provision survives, regardless of what happens to the Affordable Care Act.
There’s also increasing activity within American culture. The growing awareness of Death Over Dinner events, and the work of Pulitzer Prize columnist Ellen Goodman’s The Conversation Project offer evidence that attitudes about how we face dying may be shifting.
The Institute of Medicine in 2014 noted that, “Advance care planning conversations often do not take place because patients, family members, and clinicians each wait for the other to initiate them.”
National Healthcare Decisions Day offers a chance for us to remove barriers, complete an advance directive, and initiate a conversation about our goals of care through the end of life.
When it comes to advanced care planning, it always seems too early – until it’s too late.
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Dr. Ira Byock is the founder and chief medical officer for the Providence Institute for Human Caring.
