Imagine you’ve lived a rich, rewarding life. What would be most important to you in your dying days? Before reading further, think of at least one thing.

If you answered avoiding suffering, being with family, having the touch of others, being mentally aware or not becoming a burden to others, you are of similar mind to those surveyed who had a terminal illness.

The American healthcare system is focused on avoiding death. Twenty-five percent of all Medicare spending goes toward just 5 percent of patients in their final year of life. And in many cases end-of-life treatment occurs just because we avoid thinking and talking about our wishes.

The benefits of having this discussion with loved ones and your physician are multifold.

In a Coping with Cancer study, people who had a discussion with their doctor about their end-of-life preferences were more likely to die at peace and in control of their situation and spare their family anguish.

And after their death, their family members were less likely to experience major depression.

For most of us the dialogue is new and we could do with some tools to get the conversation started. Advance Directives is a living will, a legal document allowing an individual to record their wishes concerning end-oflife medical treatments. It’s one of the most common tools utilized today.

California’s Advance Directives can be downloaded from www.caringinfo.org/ stateaddownload.

Five Wishes, also a living will that is legal in the state of California, provides a guide to decisions about personal, emotional, spiritual and medical wishes once you become seriously ill. An excellent tool to get the dialogue started, it can be obtained for free from many senior centers.

Hospice care is an option available to those at end-of-life that focuses on helping dying patients achieve a level of comfort and freedom from suffering.

The use of hospice is growing: Almost 40 percent of dying Americans use the service today.

Common misperceptions about hospice include costs (hospice has been covered by Medicare since 1982 and is covered by most insurance providers today); the length of time one can remain in hospice (care may extend beyond six months if a patient’s condition continues to merit such medical outlook); and the viewpoint that hospice is a death sentence (hospice helps people with a terminal illness to live the fullest possible life in their remaining time).

According to Sara Creed, a hospice nurse, “The difference between standard medical care and hospice is not the difference between treating an illness and doing nothing; it is about priorities. In ordinary medicine the goal is to extend life. Hospice principles are focused on providing patients the greatest quality of life in their time left.”

Nearing end of life, Physician’s Orders for Life-Sustaining Treatment (POLST) is a vehicle to bring clarity around the difficult decisions for end-of-life care. Created by California legislation last year, this document carries the weight of being a physician order and must be honored in any emergency or hospital setting.

When used with an advance directive, POLST can prevent the initiation of unwanted or medically ineffective care, reduce patient and family suffering, and ensure that patients’ wishes are honored at the end of life.

Most often we make no choice at all, and the default leaves our ending circumstances to others. Whatever your choice—steadfast medical intervention aimed at eradicating a life-threatening illness, a focus on alleviating pain or something in between—having the conversation now with your doctor and your loved ones is the first step to ensuring you remain in control.

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