End-of-Life plans

Doctors will often try everything they can to extend a person's life*. Yet the care provided is often at odds with what the patient would have wanted; no-one wants to die in a hospital.

There maybe be several reasons for this: doctors feel professionally obliged to do everything they can, the relatives are not aware of the person's wishes, hospitals could be worried about being sued for negligence.

And the irony is that the often unwanted interventions can be very expensive.

In La Crosse, Wisconsin, every resident (of a certain age) is encouraged to create an end-of-life plan (called an 'advanced directive' in the US) which details what interventions they do and do not want (also, maybe most importantly, everyone is encouraged to talk about dying).

The plans have help ensure that the residents of La Crosse get end-of-life care more closely aligned with their wishes, it protects the doctors and hospitals, plus it costs less.

* Most doctors would not want the end-of-life treatment that they provide to their patients (http://time.com/131443/why-your-doctor-probably-has-a-do-not-resuscitate-order/)

Links

https://www.npr.org/sections/money/2014/03/05/286126451/living-wills-are-the-talk-of-the-town-in-la-crosse-wis

https://www.vox.com/2015/5/28/8672527/death-la-crosse-wisconsin

http://usa.thelancet.com/blog/2017-08-24-advance-directives-planning-end

https://respectingchoices.org/

Why the contribution is important

End-of-Life care is often unwanted and expensive.

Implementing end-of-life plans would help ensure that patients get the end-of-life care that they want, plus it would save money.

by DocMills on August 03, 2018 at 11:01AM

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Comments

  • Posted by hpsmithiom August 04, 2018 at 10:21

    The expression “end of life care” was used in speaking to me when my husband was in hospital. He subsequently died. I had no idea what the expression meant and was in total shock that he had ended up in that situation at all. I could not understand why no attempt was made to resuscitate him so to be told months later that I agreed to NOCPR is naturally devastating to me as there is no way I would have agreed.

    Staff need training in methods of ascertaining that the person they are speaking to has not only comprehended but also registered what is being said and is given the opportunity to respond.
  • Posted by Nab August 04, 2018 at 18:17

    Professionals, and all of us, maybe need to get better at discussing end of life care and I agree that implementing end-of-life plans would help ensure that patients get the end-of-life care that they want, and save money on unwanted care.
  • Posted by manxklookie August 07, 2018 at 10:01

    If someone is suffering, with no quality of life and has 'had enough' with no prospect of recovery then surely it is kinder to allow them the option of initiating an 'end of life' plan they have agreed to before they became ill. It simply makes no sense to extend life at considerable cost where it is not wanted and use that money to fund healthcare where it can provide benefit. Obviously there will need to be controls around this but it could ease considerable pain and suffering where the patient has agreed to a plan. I have seen too many cases where prolonging life at any cost has created unbelievable strain on families and resources and those requiring life changing treatment e.g cataract surgery, cardiac surgery or orthopaedic treatment have been confined to extremely long waiting lists and their health has deteriorated significantly in the meantime.
  • Posted by agincourt August 07, 2018 at 23:34

    refer back to the idea submitted about better communication!
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