January 25, 2018
Estate Planning: Advance Directives and Durable Power of Attorney for Healthcare
My husband badgered me to read Being Mortal by Atul Gwande. He, like Gwande, was a physician and as interested in dying well as he was about living life to the fullest.
Lori Zager
Several concepts are particularly worth considering:
•  End of life discussions are difficult, but according to a 2008 coping with cancer study, the terminally ill patients “who had substantive discussions with their doctor about their end-of-life preferences were far more likely to die in peace and in control of their situation and to spare their family anguish.”
•  Hospice can prolong life with less suffering and works better when started earlier. In a 2010 Massachusetts General Hospital study, “those who saw a palliative care specialist stopped chemotherapy earlier, entered hospice far earlier, experienced less suffering at the end of their lives and they lived 25% longer.”
•  Doctors die differently, often refusing gung-ho treatments with little, if any, chance of success.  My husband lectured extensively on this topic.
•  “25% of all Medicare spending is for the 50% of patients who are in the final year of life.”
Take control. Think about your wishes. Have a discussion with your loved ones about your preferences (advance directives) before something happens. Consult your attorney about including a durable power of attorney for healthcare in your estate documents. 

Gwande suggests thinking about advance directives for healthcare along these lines:
•  Who do you want to make decisions on your behalf if you can’t?
•  If time becomes short, what is most important to you?
•  What are your concerns about what lies ahead? Hopes? Fears?
•  How do you want to spend your time if your health worsens?
• How much are you willing to go through to have a shot at being alive?
•  What level of being alive is intolerable to you?
We hope these ideas will prompt you to take action.
In loving memory of Dr. Edward H. Gaston

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