IMPORTANT CONVERSATIONS

Despite the many differences that exist among people and families, I suspect that  throughout our lives we all have variations on some basic conversations. These conversations usually take place between the elders and their  younguns.  So, for example, the Easter Bunny, Santa, Boys and Girls and What Happens, disappearing Grandma and Grandpa, Assisted Care (or not),  and Death. 

Say what!? Death? Remember 2007, the year of Sarah Palin's Death Panels? If we pass the Affordable   Care Act, then government panels will decide who lives and who dies. Or variations on that theme from those determined to prevent passage of the ACA. What was proposed back then, and then withdrawn after the shameless efforts of pols like Palin, was that people should discuss with their doctors end life issues and Medicare  should reimburse doctors for the time spent in helping people to formulate an advanced care plan. 

This past summer my  younger sister passed away. When I got to her in the hospital in Florida I found that she had not made out an advanced care directive, but we were discussing what she would do after leaving rehab and without any expectation that  her death was imminent. Well.... we had that conversation anyway and a day or so  before her heart gave out  she filled out an advanced care directive. With her permission, and between visits to her in the hospital, I also found that she had pre-purchased a funeral plan.  Her will was well hidden and was not where  she said it was but I found it in the end. She passed away after about a week, in the morning just as I was leaving my motel to  visit her. As sad as her death was, I cannot easily express how thankful I was to know that she had planned in advance for exactly what happened. 

In September a Kaiser Foundatin poll found that 80% of respondents said that Medicare and private insurers should pay for the end-of-life conversations but that fewer than one in five respondents reported actually having had such a discussion with a health care provider, including only about a third of those over age 75 and about a third of those with a debilitating disability or chronic medical condition.

Many patients and families want to have these discussions, and this past summer the Myth of Death Panels was laid to rest when Medicare authorized such conversations. Under the final rule patients and families can have the discussions when and where they want — before patients become ill, after they receive a diagnosis of cancer or other serious illness, or while they are receiving hospice or palliative care. 

In such conversations, patients could discuss whether and how they would want to be kept alive if they became too sick to speak for themselves. Doctors can advise patients on options for end-of-life care, which may include advance directives to forgo aggressive life-sustaining treatment.

The conversation that you have with your  kids and/or your  doctor about the end of your life is  every bit as important as the one you and your kids had about Santa, or  any of those other essential conversations. Please do not put it off.