End Of Life Issues And Long-Term Care

What about end-of-life decisions and long-term care?

I think end-of-life decisions are something that should be discussed long before you get to the point of long term care. That's my personal opinion. I'd say all of us should let those close to us know what kinds of things we would, or wouldn't, want done. That way it makes it much easier, if and when that day comes, for them to make the decision that they know you would have wanted. It's even easier if you've got a document that's already executed. That has your signature on it. That makes it clear.

When should I start thinking about end-of-life decisions?

I think the time to start thinking about end-of-life decisions is right now, regardless of how healthy you are and so on. It's a little bit of a morbid subject matter, but it's really an important subject matter, and you'd like to think that family physicians, internists, and just regular primary care doctors would discuss that with all of their patients. In fact, in California, it's mandated that at least some form of advanced directive be discussed and the forms be offered, but it's just a very important thing and life is unpredictable. It's important to know what your parents want. They may say why are you talking about that, "Is this because you want my money?", and all those kinds of issues that come up. You do it from a place of love and you say, "I saw that lady on TV and I don't ever want to wind up like that. How do you feel about it?" Sometimes you can use maybe current events - Dr. Kavorkian or things like that, to discuss those matters with your family. But it's good to have a formalized discussion. I think that there are things that don't come easy. Sometimes maybe going with a parent to their physician, that might be a good place to discuss that and get some of the paperwork in place.

Who should know my wishes concerning end-of-life decisions?

I would say that all of your loved ones should be notified as far as what your wishes are. If you are not sure what your wishes are, then it is ok to say that too. That is why a lot of times, with a durable power of attorney for health care, you are basically nominating another person to make those decisions on your behalf because if you are incapacitated or you are unable to communicate for whatever reason, your assumption is that that person would know what you would have wanted. It is important for all of your loved ones to know, this is especially true if you are a person who does not believe in heroic measures or in prolonged life support, things like that. If there is no hope for meaningful recovery, or resuming what you would consider to be a decent quality of life - those mean very different things to different people. I think that every one of us, and everyone looking at this video, should have that discussion with the people that they care about and the people that would be likely to be making decisions on their behalf if they were ever incapacitated.