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Talking Points: End-of-Life Care

Uncomfortable but necessary topics to discuss with your loved ones—for their sakes as much as your own.

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For this month’s “The New Golden Years,” I wrote about how the baby boomers are changing what it means to be a senior and talked to experts about strategies for helping our parents (and ourselves) live life better after 65. In my research I also learned there are ways to prepare yourself to die better—better for you, and better for your family.

Chances are, you’ve thought about how you might prefer to leave this world: perhaps surrounded by family in the comfort of your own home. But the truth is one-third of Americans make the transition to that great ski resort in the sky from a short-stay, general hospital bed. Living your last days in an ICU—whether you’re alert or not—can mean many different people with varying opinions will be involved in your end-of-life care. Documents like living wills and advanced directives are useful tools to help you and your family sort through your options, but Dr. Todd Bull, a pulmonary and critical care medicine physician and the director of the University of Colorado’s Pulmonary Vascular Disease Center, says they can’t cover every contingency. Instead, having conversations with loved ones about medical decisions is what really matters. “You’re really helping your significant other, your child, your parent, whatever the situation is, deal with what is one of the more difficult things we ask people to do,” says Bull. So uncork a bottle of wine, give a toast to good health, and check off the following questions as you discuss them, book club–style—just in case.

Who’s in charge?

Unlike other states, where physicians might be instructed to defer to a spouse or oldest sibling, in Colorado, “all interested parties” have a say in the care of an incapacitated friend or family member if no medical power of attorney has been appointed. As in your BFF, crazy cousin Liz, your longtime colleague—technically anyone who’s got a stake in your life can show up. If you think your loved ones might disagree over what steps you’d want them to take, consider designating a power of attorney. “We want to make sure everyone is able to express what they think the patient’s desires are, and it’s our goal to help them reach a consensus,” Bull says. “But we honor the power of attorney [in the case of a disagreement].”

How do you define “quality of life”?

It may seem like modern medicine can prolong life almost indefinitely, but it can’t always provide a high quality of life. “If we can save your life, but you’re going to be chronically ill, a lot of people might say, ‘That’s not for me,’” Bull says. Tell your family what outcomes you consider acceptable.

What’s your pain threshold?

While this is a difficult question to answer at any age, it’s often more complicated with seniors, who may have co-occurring illnesses or simply less chance of coming out of the ICU with the same level of independence they had going in. How much discomfort—needle sticks, breathing tubes, medication-induced side effects—are you willing to put up with, and to what end?

Do you want a DNR order? What kind?

DNR (shorthand for “do not resuscitate”) orders have a menu of options to choose from. To resuscitate you, physicians might shock your heart back into rhythm; do full CPR, including chest compressions; or intubate you. You can choose which are OK, based on your values, and which aren’t; ask your primary care doc to add it to your file, and notify any admitting physician.

—Image courtesy of Shutterstock

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