Making Plans for Advanced Illness and End of Life Care

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Which people want to live as long as they can, as independently as they can. If you can make a plan, if you can say to an physician, I want this and this and this but no more and you can go out on your own terms that's what actually I would call a good death. 10, 000 boomers turn 65 everyday, they've helped their parents to grow old and what they saw really was something that they don't want for themselves.

One of the biggest things that we have to think about is the idea of advanced illness. When people get old and frail they want to be home with their families. They want to have their pain managed, they want to have their spiritual needs addressed, and above all they don't want to impoverish their families.

And in our society and in our health system we give them something else, we recycle them through hospitals, we send them to the intensive care units, we hook them up to every tube we can think of. The result of all that is heroic care that doesn't necessarily improve quality of life, doesn't even extend life, and people often die in isolation, in hospitals, in pain, and a huge expense to their families and to society.

Most people want less treatment, not more treatment. Giving a patient everything is the default. It's the default for legal reasons, for medical reasons, for all kinds of reasons. No physician sets out to torture a patient. Physicians want to do the best thing by their patients. What many physicians have said, we are poor communicators.

We don't really know how to do a good job, of eliciting what our patients want. And of course that has to start early, it has to be a continuous conversation because a patient's ideas and wants are going to change overtime, and so this is an art, this is not a science.