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Planning for the End Of Life
Ernest H. Rosenbaum, MD; Isadora R Rosenbaum, MA; Debra Marks, PhD; Sabrina Selim, MD; Thomas Addison, MD; Joanna Beam, JD; Meryl Brod, PhD; David Claman, MD; Alan J. Coleman, MD; Malin Dollinger, MD; Michael Glover; Nancy Lambert, RN, BSN; Elmo Petterle; Patricia Sparacino, RN, MS, Jeffrey Silberman, Dmin; Kenneth A Woeber, MD


With all of the changes and advances in medicine, there is more talk about issues concerning life and death. We all know that we can't get out of this world alive. But at the same time, we Americans avoid discussions about life and death.

Because major advances in medical care can now prolong life, such discussions are becoming vital to improving patient care. One has to assess the medical rationale for performing procedures and interventions, such as cardiopulmonary resuscitation (CPR) or artificial breathing (through use of a ventilator). The patient's quality of life and his or her chances for recovery have to be considered in making such life-and-death decisions.

Physicians often go to heroic lengths to keep terminal patients alive--often against the patient's wishes. Most people assume that when the time arrives for making life-and-death decisions, their physicians and family will make the choices for them. But the family's and physician's views and decisions may not necessarily agree with the patient's. We should all assess our own values regarding quality of life and make decisions on how we wish to live and the type of care we desire at the end of our life. This can be accomplished through Advance Directives and/or through filling out other forms that document your wishes about your future. Such documents give us some measure of control over our medical treatment when death threatens our survival. Through them, we can provide clear instructions if we are unable to state our wishes because a serious medical condition impairs our ability to communicate. With such documents we can also ease the burden of responsibility left to our survivors by putting our business, legal and personal affairs in order. In these ways, we can help by making decisions about our death ahead of time and so make things easier for our loved ones.

Although the Patient Self-Determination Act was passed in 1990, less than 10 to 15 percent of our population has prepared Advance Directives, which are desirable and valuable to patients, families and physicians. Advance Directives are legal documents such as Durable Power of Attorney for Health Care, the California Natural Death Act declaration, and the Prehospital Do Not Resuscitate (DNR) form. Why do so few of us complete these important forms? In part, it's a result of the fact that many physicians do not bring up the subject, because they don't want to increase the fear of death in their patients; and in part, it's because the public does not wish to make the kinds of cumbersome decisions required in completing an Advance Directive.

These topics may by their very nature be difficult issues for you. However, they represent important factors about how you may want to be treated and how you want your wishes to be carried out if you cannot make decisions for yourself. Some of the necessary documents that will help ensure that your health care wishes are recognized and included.

These topics may by their very nature be difficult issues for you. However, they represent important factors about how you may want to be treated and how you want your wishes to be carried out if you cannot make decisions for yourself. Some of the necessary documents that will help ensure that your health care wishes are recognized and included.




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