Doctors and advance directives

If your loved one and family have had the conversation about end-of-life wishes, kudos to you! In addition to writing down those wishes in an advance directive, your relative should also share them with his or her health care team.

Even if your family member is in perfect health now, that could change at a moment’s notice. It’s important to have the conversation with the primary care doctor and any specialists while in relatively stable health. Not during a crisis!

Medicare will pay

Physicians are reimbursed for having this discussion. Doctors don’t typically raise the subject. But they do respond when a patient initiates.

Here are some tips:

• Scheduling. Make a special appointment for this conversation. Tell the staff that you want to discuss end-of-life decisions. That helps the doctor prepare.
• Philosophy. Before the appointment, have your relative consider: Does he or she lean toward a “do everything” approach or prefer “no heroics, keep me comfortable, let nature take its course”? Anything he or she wants to be sure does NOT happen? Any religious beliefs or personal experiences—events with friends or family—that guide those wishes?
• Advance directive. If your relative has completed the form, make sure the doctor has a copy and it is included in the medical record.

Specific procedures

The doctor may inquire about specifics. Does your loved one want resuscitation? Tube feeding? A ventilator? Ask about the pros and cons. What is the survival rate with each procedure? And what might quality of life be afterwards? (Broken ribs from CPR? Infections from a ventilator…?)

Your relative needs to have this discussion with the doctor—and the family—while still able to convey concerns and priorities. With end-of-life wishes, “It’s always too soon … until it’s too late.”

Is this a difficult subject to bring up? You are not alone! As the Roanoke and Lynchburg experts in family caregiving, we at Gentle Shepherd Hospice understand that it’s a sensitive topic. We can help. Give us a call at 1-800-789-0586 (toll-free).