What is a Full Life?

Watching the Fox News Sunday program this morning prompted me to consider a hot topic in the health care reform discussion : End of Life counseling. Their discussion focused on materials that health care providers to veterans were required to refer their patients to. The booklet "Your Life, Your Choices" had a worksheet that guided the veterans in making decisions on advanced care planning. If you haven't heard of this terminology it includes living wills, do not resuscitate orders, and advanced directives to physicians. The big hubbub was about the inferences made by some of the questions that the veteran might be better off dead than to live in a wheelchair or other non-terminal disability.

Let me start this by saying that I am in favor of advanced care planning. Living wills and advanced directives are important for a person to prepare so that loved ones will know his or her wishes. Too many times a person is incapacitated and the family is not aware of their wishes and a struggle ensues as to how to proceed with care. Some family members want all means possible and some want Momma on a Viking funeral pyre. Without anything written down know one knows what an individual wants. A second and just as important part after the directives are prepared is a frank and open discussion of them with the family. A face-to-face with the family can save much grief at a time of suffering the loss of a loved one. Unfortunately only a very small numbers of people have done such planning and the problems continue.

The key omission in the previous paragraph is the role of the government. THERE IS NONE!!!! Our benevolent leaders, who know what is best for us, is on a campaign to get people in any government supported facility to prepare advanced care planning documents. This started a couple of years ago when Medicare put a requirement that advanced care planning be addressed within 14 days of admission to a nursing home. At such time the resident asked to decide many end of life issues such as "Do you want to be a DNR?" "Do you want your life prolonged by artificial means?" These are decisions that should only be made after much consideration, not in a moment of debility or illness. So the government comes along and makes this a centerpiece of health care reform and the inference drawn from it is that these advanced directives are going to be used to deny care to the elderly. If the government is that sinister then it is way past time for another revolution!

Here are some key points on advanced directives:

1. They are only as good as the person chosen to see that they are carried out. Choose your Medical Power of Attorney wisely! The pressures that can come to bear on this person are enormous and you don't want Sara Milktoast in charge of it.

2. Make sure the documents are legally executed, especially the Medical Power of Attorney. This requires notarization of your signature and witnesses.

3. Prepare your advanced directives while you are healthy and of undisputed "sound mind". Just a precaution to eliminate the question.

4. If you have questions about end of life issues ask your doctor. He or she should be able to answer your questions regarding medical treatment, effects of afflictions such as heart attacks and strokes, and living on life support.

In answer to the question in the title, a full life is what YOU say it is. Not me, the government, your kids, or some doctor. I see people in their 90's every day living a full life, engaged in the activities of daily living just as you and me. Their bodies don't work like they used to but they have faced tougher challenges than a wheelchair. As the saying goes "old age is not for sissies".