April is Advance Health Care Directive Month

The weather is beautiful this week in the Bay Area. Last weekend I drove out to Rancho Nicasio: the hills were green, Nicasio Reservoir looked full, cows were grazing on the hills, it was beautiful!

I read an opinion piece in the New York Times recently by Jessica Nutik Zitter, M.D. suggesting that death education be offered in schools, teaching young teenagers about the realities of the I.C.U. compared to a medical TV show “save.”   In Dr. Zitter’s view, we are not able to plan for the death of our choice, or at least a death consistent with our values, because we often do not know how close we are to dying. Many patients end their lives in the I.C.U., burdened by medical procedures that are not likely to prolong life. In contrast, studies indicate the majority of Americans say that they would prefer to die at home.

I believe that doctors also need death education, but the focus for doctors would be how to talk to patients about how close death really is.  Many doctors are calling for a new approach already, pointing out how medical school necessarily focuses on saving life and preserving health, leaving little time for training on end of life issues and palliative care. These discussions would likely be difficult- which is all the more reason to include training on this topic.

When I prepare clients’ advance health care directives we typically talk about how they can best ensure that their health care wishes are followed. I recommend honest and sometimes soul searching conversation with their named agents regarding end of life wishes.  Whoever you have named as your agent must be ready to stand up for your choices and values with medical personnel. If your agent does not feel that they could do so, that person may not be the best choice for agent. For example, would a close friend or family member be able to argue for the removal of life support (if that would be your wish)? Or is your agent someone who believes in not taking all measures to prolong life, when you would want all measures taken? This is a discussion that needs to happen with your agent.

Call me if you would like to discuss naming an agent for health care. And happy spring, get out there and enjoy the warm weather or go for a drive.