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Immunity to Medical Caregivers in Colorado.
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Compassion in Dying End-of-Life Choices
- Our Mission
We are a non-profit organization dedicated to education (see Events tab) regarding end-of-life issues and choices in dying.
- Our Vision
We believe that in a free society it is a fundamental right to choose the time and manner of one’s death. The right to choose the course of one’s death is as fundamental as the right to choose the course of one’s life. Our vision, therefore, in a free society, is to support choices in dying, including physician aid in dying.
BACKGROUND
The right to choose the course and manner of one’s death should rest only with the individual, not with the government, religious bodies or medical associations.
We hold that individuals have the right to follow their beliefs – whether religious or philosophical – about how death should occur. However, they should not be able to force their views and convictions on other members in a democratic society. No one should be compelled to experience a protracted, painful death.
We discourage suicide for emotional reasons in the absence of terminal illness and we support the work of suicide prevention organizations.
We endorse home-care and hospice programs which offer compassionate medical, nursing and social work services to dying patients.
NEWS
6/21/08 Members of the Colorado Advance Directives Consortium discussed the MOST form MOST Final Draft, and how to go around the state and present it to various health care facilities. It is predicted that MOST will be finally approved by the Health Department by the end of 2008. This will be a huge step forward in providing a simple, condensed form of Advance Directives and DNR orders for the many people who don't know about or have not completed such documents.9/28/07 Compassion & Choices of Colorado has recently revised its state-specific model Advance Directives together with associated documents related to end-of-life choices. We would recommend that all members take a look at the web site attachment Advance Directives which can be opened with Adobe Reader and easily printed,
7/17/07 Mayo Clinic does it again. Their site Living wills and advance directives: Tools for medical wishes contains a terrific amount of excellent information regarding these important topics.
6/9/07 CALIFORNIA LEGISLATION: Not good news. One day before the June 8 deadline in the Assembly, lawmakers have declined to bring AB 374 to a vote. The legislation would have given terminally ill Californians the option to request life-ending medications from a physician to hasten an impending death.
2/5/07 Life on her terms: Patient eschews aggressive treatment for 'bonus year'. LA Times article by Susan Brink
4/17/06 Mayo Clinic has a terrific site whose subject matter is:
Interacting with a terminally ill loved one.6/1/2006 Immunity to Medical Caregivers in Colorado. Major Liability Relief!
3/20/06 Tips on Finding and Using a Hospice. TOP
Check your advance directives!
One should be aware that in senior communities they may have policies that differ from one’s final directives. Therefore, it is best to request that these final directives be signed off in advance so that the organization can follow them.For dementia, one can put in final directives that a feeding tube should not be used. This enables one's healthcare proxy to enforce this request.
Since the passage of HIPAA (Health Insurance Portability And Accountability Act) we’ve all been signing new forms at the doctor’s office or at the hospital. It has come to our attention that we might need to check our advance directives to be sure our proxies will be authorized to have access to all the medical information they will need to execute our wishes. Local attorneys do not know of any instances of such difficulties occurring, but suggest making appropriate changes the next time you review or update your directives.
We are also affiliated with or previously known as:
Compassion & Choices
Hemlock Foundation
Caring Friends
Compassion in Dying
Hemlock Society
OTHER C & C CHAPTERS Immunity to Medical Caregivers in Colorado.
Members of the Colorado chapter of Compassion & Choices joined forces with other like-minded organizations to help shepherd the passage of Colorado SB 102. The Act, which was signed by Governor Owens on April 4, becomes effective on July 1, 2006, and amends the state’s current Manslaughter statute 18-3-104 by stating “This section (manslaughter) shall not apply to a medical caregiver with prescriptive authority or authority to administer medication who prescribes or administers medication for palliative care to a terminally ill patient with the consent of the terminally ill patient or his or her agent.”
Simply put, the new law grants immunity to a medical caregiver who unintentionally causes the death of a terminally ill patient as the result of efforts to relieve the patient’s pain by either using increased doses of medication or administering analgesics the physician might otherwise be reluctant to try. Adequate pain management in the United States is extremely poor; 50% of patients who die in institutions experience pain that could be treated, but isn’t.
Barriers to proper pain control include concerns over government scrutiny when prescribing Schedule II drugs, the possibility of patient addiction, and the fear that aggressive efforts to relieve pain might unintentionally cause a patient’s death. While there is still a long way to go in improving end-of-life care in Colorado and elsewhere, SB 102 at least removes one of the barriers, and hopefully will encourage more Colorado physicians to be more aggressive in their efforts to relieve patient suffering.Tips on Finding and Using a Hospice
Your community may have several hospice organizations or only one. Check your phone book under “Hospice.” Remember that hospice care is most often provided in the home, though there are some “inpatient” hospice facilities for those who cannot stay at home. Hospice does not provide round-the-clock care in the home.
Things to consider:
Some insurance companies pay for care given only by a particular hospice. When you call a hospice, they will tell you if they take patients with your insurance.
It is always a good idea to ask the doctor who is making the referral to hospice if she/he prefers a particular hospice. This doesn’t mean you have to go to that hospice, but your doctor or the nurse in your doctor’s office may have some insight into the reputation of a particular hospice.
You may also want to speak with friends or family members who have experience with hospices in your community. They may give you some tips as well.
Hospices are either for-profit or not-for-profit. In most cases, both provide excellent services. The reputation and practice of a hospice is more important than whether they qualify as a nonprofit organization.
In order to receive hospice care, most agencies require that the patient have a primary caregiver while they are at home. If you do not have someone who can provide care for you in your home, hospice may be able to offer some suggestions/solutions. Ask them for assistance.
The organization for hospices is called The National Hospice and Palliative Care Organization (NHPCO). Hospices can become members of this organization by paying a fee. You can see these hospices listed on the NHPCO website at www.nhpco.org . Membership in this organization does not mean their care will be better than other hospices. It is simply one place to start your research.Researching particular hospices:
Call the hospice and ask to speak to an intake person. Explain the patient’s situation. Ask if they see patients in your area.
You might want to ask them how long they have been in business and how many patients each nurse sees on an average day. The fewer patients a nurse is expected to see in a day, the more time they will have for each patient. Older hospices tend to have more experience, but that shouldn’t rule out a smaller hospice, unless they have been in business only a year or so.
Have them describe their services.
Ask them if you will be able to continue to see your own doctor (some hospices ask you to use their doctor – though this is rare.)
Ask them to describe their philosophy of pain management. Listen for words that make sense to you, like: “Our goal is to keep the person out of pain, and this is almost always possible.” If they say something like “not all pain can be controlled, but we do our best,” be concerned.
Find out what they do if a patient needs more care than that which can be delivered in the home. Do they have a particular facility with trained hospice nurses (this is ideal) or do they admit the patient to a nursing home with hospice support?
Are they affiliated with a religious institution? If they are, ask how that affiliation influences the care delivered and the end-of-life options available.
Ask where they stand on palliative sedation. Use words such as: “If Dad’s pain or symptoms become impossible to manage, would you provide IV medication to sedate him enough so he can be completely comfortable until death occurs?”
Ask them what their weekend and night coverage is like (there should be a nurse available by phone 24 hours a day.)
Listen for the level of concern and kindness in the voice of the person you speak to. Does he/she respond thoughtfully to your questions?
If you have any questions, please contact Compassion & Choices. 1-800-247-7421 or Compassion & Choices-National The staff and volunteers will be happy to talk with you.
Life on her terms
Like Art Buchwald, more terminally ill patients seem willing to forgo medical intervention. 'Enough is enough,' they say.
By Susan Brink, LA Times Staff Writer February 5, 2007
FOR the last couple of years, Vailia Dennis, 87, has wondered if there existed, on the face of the earth, even one other human being who thought as she did about death. Then she read about Art Buchwald, the newspaper columnist who died at the age of 81 on Jan. 18, nearly a year after he opted out of further medical treatment, preferring to put himself in the hands of fate.
TOP
At last, Dennis thought. A soul mate. "I read about Art Buchwald and I discovered that we were like blood-related creatures," she says. Buchwald refused kidney dialysis. He went on to outlive doctors' predictions by almost a year, time he spent holding court with the fabulous, the famous and the powerful, and by all accounts, having a great time.
Dennis refused open-heart surgery, enrolled in care at the San Diego Hospice & Palliative Care and, within the familiarity of her San Diego home, has outlived predictions of her demise so far by two years. "This has been the most comfortable, the most interesting, time of my life," she says.
Dennis doesn't run into a lot of people who understand her decision to say "No, thank you," to medical intervention, but those who do are out there — more of them, it seems, each year. About 1.2 million patients, 80% of them older than 65, received hospice services in 2005, an increase of 150,000 from the year before and up from 210,000 in 1990, according to the National Hospice and Palliative Care Organization.
Certainly, not all of them are rejecting further treatment. Many have simply exhausted all that medicine has to offer. But end-of-life experts say there are hints in the numbers that point to a trend toward more people being willing to call a halt to aggressive treatment. The average length of service to a hospice patient has increased from 48 days in 2000 to 59 days in 2004, suggesting that people are coming to the services sooner in the course of their diseases.
"The decision that Art Buchwald made is actually not so unusual," says Dr. David Casarett, professor and geriatrics researcher at the University of Pennsylvania and chairman of the American Geriatrics Society's ethics committee. "A lot of people decide that the burdens of continued treatment outweigh the benefits. They don't want to go through another hospitalization or another surgery."
Or they don't want another grueling round of chemotherapy with no chance of cure and very low odds of improvement, or a second or third heart transplant. An increasing number of elderly people have been sick for a long time and have gone through the medical wringer long enough to know when they want to say "Enough is enough." "In fact, I would spin it around," Casarett says. "There are still a few people out there who want aggressive treatment all the way to the end. But I would go out on a limb and say the majority of people don't want that."
They prefer a graceful exit on their own terms. "Art Buchwald is a perfect example. He lived for months with a good quality of life," says Diane Meier, director of the Center to Advance Palliative Care at Mount Sinai School of Medicine in New York. "He said, 'I'm not going to play,' and lo and behold, nothing bad happened. He didn't get caught up in grasping at all straws, and he didn't spend his last days tethered to a machine."
It's a decision that can be difficult for loved ones to accept. Maybe a parent is ready to let nature take its course but children resist, or siblings disagree, or a spouse cannot let go. Sometimes it's the medical establishment that won't give up the fight. "In our culture, we have a unique, almost religious, faith in medical technology," Meier says.
But watching a relative suffer through the final, ultimately futile, throes of medical heroics can diminish that faith in technology. Dennis was her brother's caretaker after his second of two open-heart surgeries. She watched him deteriorate, bed-bound and mentally unaware during his final months. She'd seen enough to say "no" when doctors told her she needed open-heart surgery for her hypertrophic cardiomyopathy, a condition that causes a thickened wall inside the heart.
"I flatly didn't want to go through that," she says. "I know the stresses you go through just trying to recover enough to walk. I didn't know if I would come out of it being who I am now, with the same independence, the same determination, the same ability to laugh. I thought it could take away a part of me that I didn't want to give up."
She and Buchwald both outlived medicine's predictions for them, but that is not uncommon. A much misunderstood aspect of hospice care, says Dr. Charles von Gunten, vice president of San Diego Hospice & Palliative Care, is that they kick you out of the program if you live past a certain point.
To get Medicare or insurance coverage for hospice, a patient needs a prognosis of six months or less. "That means six months if the disease runs its normal course. It's an average," Von Gunten says. "There are plenty of people enrolled in hospice care for years."
But for coverage to continue, people have to show signs of getting worse, not better. Those Medicare regulations attached to hospice coverage can disrupt end-of-life care and send a patient from one group of providers to another. (Although hospice coverage ends, Medicare continues coverage of other medical expenses.) Experts call it the hospice "failure to die" problem. If a patient stabilizes in hospice care, Medicare coverage for the program stops within a few months, says Joanne Lynn, of the Office of Clinical Standards and Quality at the Centers for Medicare & Medicaid Services.
"It can be a major disruption," she says. It means leaving nurses, aides and other providers that patients have come to know as they go back and forth between traditional medical care and hospice care, depending on how accurately physicians have predicted their decline. It's why Buchwald cracked, in a March 7, 2006, column: "I've gotten so well Medicare won't pay for me anymore."
About 18% of hospices offer inpatient care, either in free-standing hospice facilities or within hospitals. But most hospice patients are cared for in the place they call home — private residences or nursing homes. Buchwald, for example, began hospice in a residential facility but later moved to a wing in his son's home.
Patients in hospice care live longer than patients with similar conditions who are not in hospice care, according to a September 2004 study in the Journal of Pain and Symptom Management. Researchers studied 8,700 Medicare patients with 16 different terminal conditions and compared those who went to hospice care with those who did not. Researchers compared the patients' longevity and found that for all conditions, patients in hospice lived longer by days to months.
And for most conditions, the study found, the cost of care was lower for patients in hospice. Those with congestive heart failure, one of Dennis's health problems, lived nearly two months longer in hospice care, and the cost of their care was less by almost $9,000.
That kind of cost savings will be increasingly important as the the baby boom generation gets older and sicker. Though healthcare costs overall average $7,365 a year for Americans, the costs during the last year of life for those 65 and older skyrocket to $37,581, according to a study of Medicare spending in the December 2002 issue of the journal Health Services Research. The cost of the last year of life for all Americans, the study found, accounts for 22% of the nation's annual healthcare bill.
Getting a little more time for a little less money was not what drove Dennis's decision. And though she wanted no more aggressive medical intervention, she did want care— psychological, spiritual and medical—for such things as pain and symptom management.
"I'm living in my own home, by myself. I could not be doing this without hospice," she says. "My fears are minimal, but when I'm not doing well, there's someone I can call. A nurse visits me weekly, more if I need it. The chaplain comes once a week because we enjoy talking to each other. A woman comes three times a week to help me shower. And a social worker is available for anything I need."
She has used her bonus years to spend time with her children and grandchildren and to paint, read and write. As an octogenarian, she has fearlessly plunged into learning what computers can do, setting up a website and blog. "I'm free," she says. "I eat when I want to eat. I'm adept at the Internet, so I can look up whatever I want to learn."
Like Art Buchwald, she is showing that there can be a quality-of-life advantage to giving up medical treatment when medicine's promises diminish and fade. J. Donald Schumacher, president of the National Hospice and Palliative Care Organization, visited Buchwald during the writer's last year, witnessing one of the magical moments Buchwald loved so much. "When I walked in, Lauren Bacall was on the phone," Schumacher says. "She was calling from London."
