Op-Ed

Advanced planning can allow you to make choices about end-of-life care. Here's how.

Former first lady Barbara Bush listens to a patient’s question during a visit to the Barbara Bush Children’s Hospital at Maine Medical Center in Portland, Maine, on Aug. 22, 2013. A family spokesman said Sunday, April 15, 2018, that the former first lady is in “failing health” and won’t seek additional medical treatment.
Former first lady Barbara Bush listens to a patient’s question during a visit to the Barbara Bush Children’s Hospital at Maine Medical Center in Portland, Maine, on Aug. 22, 2013. A family spokesman said Sunday, April 15, 2018, that the former first lady is in “failing health” and won’t seek additional medical treatment. AP

Barbara Bush, the wife of a former U.S. President and mother to another, died this week at 92 after announcing that she would not seek ongoing medical treatment to prolong her life. She opted to focus on comfort care, which likely included medication to alleviate or lessen any pain.

We learned from the news reports that Mrs. Bush discussed her decision with both her medical providers and her family. This is validating news to those of us who help people make end-of-life decisions about how they want to live … and die.

Research confirms that advance care planning is perceived as an important healthcare process. In its absence, serious — even tragic — consequences for patients and their families can occur. Inappropriate care and family conflict can result when advance care planning is not addressed. When advance care planning is discussed well ahead of a crisis, multiple benefits accrue, including peace of mind, better decision-making, less chaos and conflict among family members.

A Western Washington University student was urgently summoned by her mother's physician. Her mother was on life-support with a swelling brain, and a multitude of other problems, with no expectation of recovery to meaningful capacity. An only child of divorced parents, this distraught daughter unexpectedly became her mother's healthcare surrogate. She and her mother had never discussed end-of-life healthcare wishes. After much soul-searching, she chose comfort care for her mother, who died within 24 hours. Nearly a decade later, this young woman carries a heavy burden, wondering almost daily, "What would mom have wanted? If only we had had the conversation."

A local nephrologist has publicly stated he views it as "unnecessarily cruel" to loved ones to ignore advance care planning. Family members of seriously ill patients who die and who did not make their wishes known often suffer from post-traumatic stress disorder when it is left up to them to make the decision to withdraw life support in futile situations.

PeaceHealth is a partner in Honoring Choices Pacific Northwest, an initiative of the Washington State Medical Association and the Washington State Hospital Association. As a partner, PeaceHealth is committed to provide much-needed information to the public, and to its caregiver workforce, to reduce the number of tragedies that occur when a person’s healthcare wishes are unknown.

Dr. Gib Morrow has been named "physician champion" in the Honoring Choices Initiative. We are working with clinicians so that they are better prepared to initiate high-quality conversations about advance care planning with their patients and to integrate the results of these discussions into future care plans. We also encourage patients to initiate these important talks with their doctors and other clinicians, as a shared responsibility approach.

In my new role as program coordinator for advance care planning, we are offering interactive workshops to guide participants through the process of choosing a healthcare agent and documenting their healthcare wishes. The free workshops are scheduled for the first Thursday of each month, beginning May 3. Registration is required because space is limited.

An important first step in this process is to have the conversation with your family and close friends about what medical interventions you'd want or not want if you became incapacitated and couldn't speak for yourself. National Healthcare Decisions Day was April 16. Although the day has past, it’s still a good time to share your values, thoughts and wishes with someone close to you if you haven't done so already.

Our hope is that everyone has the opportunity to live the way they wish, through each chapter of their life story.

Hilary Walker is program coordinator for Advance Care Planning at PeaceHealth Medical Group, St. Joseph Medical Center in Bellingham.

About the workshops

The free workshops on advance care planning are scheduled for the first Thursday of each month, beginning May 3. Registration is required because space is limited. Contact HWalker@peacehealth.org for information.

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