One of the great ironies of American life is how strenuously many people avoid discussing life's most unavoidable outcome: dying.
It's creepy. It's bad luck. It's in God's hands. It's too complicated. I'm OK with it, but it freaks out my (fill in the blank) to even say the word "death."
Whatever the reasons, the result of avoiding the subject can be a completely avoidable loss of control over crucial end-of-life decisions.
Most people can deal with death from a distance, if it can be kept at least somewhat hypothetical. It's relatively easy for individuals to tell researchers that they would like to die at home, comfortable and free of pain, and surrounded by loved ones.
But a new survey of community attitudes on death and dying in Eugene and Springfield found significant gaps between what people wanted for themselves and their loved ones at the end of life and what they received. In almost every case, those gaps could have been eliminated if people had taken a few specific steps to explicitly state their wishes for end-of-life care.
Here's the catch: If you want to be sure your loved ones have the peace of mind of knowing they're doing what you wanted if you are incapacitated and can't communicate, you should formalize your wishes in a legal document called an advance directive.
Don't panic. This isn't a will. You should also have a will, but that will be much easier to think about after you've practiced by completing an advance directive.
Procrastination prevents about two-thirds of the people who think it would be a good idea from getting around to completing an advance directive. A lot of dogs probably get bathed as a result of someone weighing whether to sit down and fill out an Oregon Advance Directive form.
The main problems with procrastination are things such as car accidents, strokes, heart attacks and head injuries. If you can't speak for yourself, and you haven't thoroughly explained your wishes to your family, they'll be on their own making decisions about your care. This will compound their anxiety and grief.
A thorough and thoughtful collection of everything you need to know about preparing an advance directive, including tips on how to raise the topic with reluctant family members, is available on the Internet at www.seriousillness.org/lane.
Hospitals are the place to be for an all-out battle to beat illness or injury, but when it's clear the war is soon to be over, 98 percent of patients want to surrender in their own homes. Despite that wish, one-third of survey respondents in Lane County said their loved one died in a hospital.
Twenty-seven percent died at home with hospice care, but another 17 percent of those who died at home did not use hospice services. The survey concluded that the most direct way to improve end-of-life care is to increase the number of people who receive hospice care, which is available through a doctor's referral to anyone who has six months or less to live.
Hospice care is a godsend. Hospice workers understand the needs of dying patients and their loved ones like no one else in the health care system.
In addition to dying at home, people want their pain and symptoms managed in ways that keep them comfortable. But only 38 percent of respondents said their loved ones' pain had been managed "very well."
In a revealing disconnect between the desire for pain relief and acceptance of impending death, a number of survey respondents raised concerns about becoming addicted to pain-killing drugs. Addiction isn't a meaningful issue for someone in the last few months of life, and these survey results help to remind health care professionals to allay such fears for their terminal patients.
Like talking with children about sex, discussing death and dying can be uncomfortable at first. But the initial unease usually gives way to enormous relief as family members overcome their fears and feel empowered to honor a loved one's last wishes.
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|Title Annotation:||Editorials; Planning makes end-of-life care less stressful|
|Publication:||The Register-Guard (Eugene, OR)|
|Date:||Nov 22, 2004|
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