END OF LIFE DECISIONS

When we go to the hospital we are asked if we have a "Living Will" aka LIFE DIRECTIVES. I do, and it is my hope that it will be followed to the way I described. But that might not be the case if the H.R. 3200 "Health Reform Bill" passes with the language that is written in it. When a State passes a law other States usually follow suit.
I found this to be helpful:

Statement by House GOP Leaders Boehner and McCotter on End-of-Life Treatment Counseling in Democrats’ Health Care Legislation

Washington, Jul 23 -

House Republican Leader John Boehner (R-OH) and Republican Policy Committee Chairman Thaddeus McCotter (R-MI) today issued the following joint statement regarding a provision targeting seniors contained in Section 1233 of H.R. 3200:

“Section 1233 of the House-drafted legislation encourages health care providers to provide their Medicare patients with counseling on ‘the use of artificially administered nutrition and hydration’ and other end of life treatments, and may place seniors in situations where they feel pressured to sign end of life directives they would not otherwise sign. This provision may start us down a treacherous path toward government-encouraged euthanasia if enacted into law. At a minimum this legislative language deserves a full and open public debate – the sort of debate that is impossible to have under the politically-driven deadlines Democratic leaders have arbitrarily set for enactment of a health care bill.

“This provision of the legislation is a throwback to 1977, when the old Department of Health Education and Welfare proposed federal promotion of living wills for cost-savings purposes described as 'enormous.' At that time, the late Cardinal Joseph Bernardin of Chicago decried this effort by saying: 'The message is clear: government can save money by encouraging old people to die a little sooner than they otherwise would. Instead of being regarded with reverence, and cherished, human life is subject in this view to a utilitarian cost-benefit calculus and can be sacrificed to serve fiscal policy and the sacred imperative of trimming a budget.'

“With three states having legalized physician-assisted suicide, this provision could create a slippery slope for a more permissive environment for euthanasia, mercy-killing and physician-assisted suicide because it does not clearly exclude counseling about the supposed benefits of killing oneself.

“Health care reform that fails to protect the sanctity and dignity of all human life is not reform at all.”

This bill really scares me, I think we are going to lose many of our Constitutional Rights if this bill passes. I am against this bill and have told my Senators and Represenatives how I feel. They also know how I will vote the next time they come up up for election if they vote this frightening bill into law.
Just my thoughts as I face what life I have left here on earth. I will not give up on fighting for the good of the American people.

By Jamaicanmenuts
Posted August 1, 2009 at 8:31 am
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I spent time reading the bill yesterday and I understand exactly what you are saying.
The language regarding end of life decisions is written in a subtely negative form.
So it is imperative that we research each state's "tool kit" when preparing our directives.

Once again Congress is rushing to pass a bill which is not available to everyone for public view. Unless you have a computer or access to a library's computer this info is not being presented properly by the main stream media.

It will NOT be my patriotic duty to die.

By lkay
Posted August 1, 2009 at 8:34 am
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We have the ability to prolong life for well beyond the time our bodies should sometimes be expected to perform to....

I read the legislation as wanting everyone to understand informed consent not only to withhold treatment but also to begin treatment. We need to fully comprehend the ramifications of both.

I don't see this as encouraging suicide or euthanasiam, but allowing patients to make educated decisions about their own lives. Thanks for bringing this one up for discussion.

Laura

By Bellafia
Posted August 1, 2009 at 8:55 am
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Laura, It is extremely important to understandstand the Language in this bill and to know that when States pass a law into effect, it ususally follows at some point that other States follow suit, suffice it to day, I have learned that euthanasia and abortion go hand in hand. Therefore unless abortion is explicity excluded from the scope of any federally mandated, federally subsidized, or federally defined health insurance plans this health care bill includes Medicare.

The $64,000 question has been answered yesterday:

FINALLY...THE $64,000 QUESTION WAS ASKED...
YESTERDAY ON "ABC-TV" (BETTER KNOWN AS THE ALL BARRACK CHANNEL)
DURING THE "NETWORK SPECIAL ON HEALTH CARE".... OBAMA WAS ASKED:

"MR. PRESIDENT WILL YOU AND YOUR FAMILY GIVE UP YOUR CURRENT HEALTH CARE
PROGRAM AND JOIN THE NEW 'UNIVERSAL HEALTH CARE PROGRAM' THAT THE REST OF US WILL BE ON ????"..... (BET YOU ALREADY KNOW THE ANSWER)...
THERE WAS A STONEY SILENCE AS OBAMA IGNORED THE QUESTION AND CHOSE NOT TO ANSWER IT !!!...

IN ADDITION, A NUMBER OF SENATORS WERE ASKED T HE SAME QUESTION AND THERE RESPONSE WAS..."WE WILL THINK ABOUT IT."

AND THEY DID. IT WAS ANNOUNCED TODAY ON THE NEWS THAT THE "KENNEDY HEALTH CARE BILL" WAS WRITTEN INTO THE NEW HEALTH CARE REFORM INITIATIVE ENSURING THAT THAT CONGRESS WILL BE 100% EXEMPT !

SO, THIS GREAT NEW HEALTH CARE PLAN THAT IS GOOD FOR YOU AND I... IS NOT GOOD ENOUGH FOR OBAMA, HIS FAMILY OR CONGRESS...??
WE (THE AMERICAN PUBLIC) NEED TO STOP THIS PROPOSED DEBACLE ASAP !!!!... THIS IS TOTALLY WRONG !!!!!

PERSONALLY, I CAN ONLY ACCEPT A UNIVERSAL HEALTH CARE OVERHAUL THAT EXTENDS TO EVERYONE... NOT JUST US LOWLY CITIZENS... WHILE THE WASHINGTON "ELITE" KEEP RIGHT ON WITH THEIR GOLD-PLATED HEALTH CARE COVERAGES.

IF YOU AGREE PLEASE PASS THIS O N ....IF NOT PLAN TO SUFFER WITH THE OBAMA HEALTH CARE PLAN ....FOR FREE.... WHILE OUR SELF-SERVING POLITICIANS MAKE SURE THAT THEY TAKE CARE OF THEIR BUTTS AT OUR EXPENSE.

I agree that every member of Government from the TOP to the LOCAL should have the same plan they propose for the people of America. Are they any better than US that THEY SHOULD BE EXEMPT????

By Kennarina
Posted August 2, 2009 at 11:06 am
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There are a couple issues here (end of life decisions plus a later 'same health care for all' discussion) I'd like to address the original first point.

I'm just an outsider (Canadian) but I have to jump in here to agree with Laura. This is the kind of inflammatory U.S. fear-mongering that we've been observing from up here. I wish all Canadian doctors were being 'encouraged to provide patients with information about end-of-life treatments'!!!!

I've spent the last nine years working in hospice palliative care, and I can tell you that we wish ALL of our patients had had the foresight to sign a document that will speak for them when they are unable to speak. This means both what they DON'T want done (heroic, futile, life-prolonging measures) and what they DO want done (heroic, futile, life-prolonging measures). Either way, care providers are mandated to follow the patient's directives.

The founding belief of hospice care is that we don't prolong life and we don't hasten death. That is the natural state for human beings at the end of their lives. None of us is getting out of here alive, folks.

If you don't put your own end of life care preferences in writing, your family might be fighting tooth and nail over this decision when you are no longer able to make a choice yourself - and take it from me, this is an ugly and chaotic scenario.

Every one of us needs to have not only the document in place, but the big conversation with our families. Today! You would not believe the common sight of families arguing ferociously around a comatose grandma's bedside about what "grandma would want" because grandma has put nothing in writing about what kind of care she does want at the end of her life.

We see families who insist on implementing CPR and feeding tubes and artificial hydration even as grandma is choking and suffering with pulmonary edema because her body is unable to cope with these futile measures. This is a miserable and horrific way of dying - and yet I've seen family members who forcefully demand such measures.

The decision to withhold futile measures is not 'euthanasia', by the way. This is a scary word that opponents like to wave around.

Your politicians who talk glibly about 'preserving the sanctity and dignity of all human life' are likely those who have never witnessed artificially prolonged death through the miracle of medical technology. For that's what you are prolonging - not life! There is nothing sanctified or dignified about such a death.

We live in such a death-denying culture that some people seem to believe that life must be prolonged at all costs, even when it inflicts suffering and misery on the poor patient involved. This is why an advance directive is so important for every single one of us.

Here's an old nurses' joke:
Q: Why are there nails in coffins?
A: To keep the oncologists out.

Translation: if you don't want futile life-prolonging and expensive care at the end of life, you must let others know this ahead of time. That's what this legislation is about. But if you do want your caregivers to pull out all the stops right up to your final breath, you must let others know that, too.

How do you want to die?

A 'living will' or 'advance directives' are legal tools to help you inform your care providers what you want, no matter how that looks or WHAT YOUR FAMILY WANTS. If for example, you're worried that your family is going to somehow pressure you into signing up for assisted suicide - if it's legal in your state - because you're a burden, then SIGN YOUR DIRECTIVE today, outlining what you DO want instead! (By the way, read more on Oregon's Death With Dignity legislation that's been in place for several years - you couldn't be pressured into 'signing up' for assisted suicide without a number of rigid assessment steps (like having two independent physicians confirm that you do have a terminal prognosis of less than six months, have intractable symptoms, etc.) This is no 'slippery slope'.

Those of us who work in end-of-life care here have a keen interest in the U.S. experience with legalized physician-assisted suicide (which is not and never will be defined as euthanasia, contrary to those hysterical opposition claims - they are two different animals). I'd encourage those of you who are really concerned to actually read what's been happing in Oregon. Results there have been extensively studied, well-documented and published widely. It will surely ease the minds of those who mistakenly believe that somehow this will mean doctors are willy nilly knocking off little old ladies in seniors' homes.

<< "...a bill which is not available to everyone for public view. Unless you have a computer or access to a library's computer this info is not being presented properly by the main stream media..." >>

Well, 'a computer or access to a library's computer' would include pretty well everybody, wouldn't it?

This is such a complex issue, but it's important not to muddy the already swirling waters with inflammatory or exaggerated claims that are simply not based in fact - like the good Cardinal's quote about human life being 'sacrificed to serve fiscal policy'. Good grief.....

XOXOXO

http://www.myheartsisters.org

By Bronte
Posted August 2, 2009 at 1:27 pm
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This is such an important topic for all especially us patients with heart problems. After my bypass, I had a living will and advance care directives drawn up. It was not very expensive and gave me peace of mind knowing that my family/doctor knows my wishes.

It seems that there is much misinformation about some issues of the health care reform. Below is a fact check article from Associate Press

FACT CHECK: Distortions rife in health care debate
By CHARLES BABINGTON (AP) – 2 hours ago

WASHINGTON — Confusing claims and outright distortions have animated the national debate over changes in the health care system. Opponents of proposals by President Barack Obama and congressional Democrats falsely claim that government agents will force elderly people to discuss end-of-life wishes. Obama has played down the possibility that a health care overhaul would cause large numbers of people to change doctors and insurers.

To complicate matters, there is no clear-cut "Obama plan" or "Democratic plan." Obama has listed several goals, but he has drawn few lines in the sand.

The Senate is considering two bills that differ significantly. The House is waiting for yet another bill approved in committee.

A look at some claims being made about health care proposals:

CLAIM: The House bill "may start us down a treacherous path toward government-encouraged euthanasia," House Republican Leader John Boehner of Ohio said July 23.

Former New York Lt. Gov. Betsy McCaughey said in a July 17 article: "One troubling provision of the House bill compels seniors to submit to a counseling session every five years ... about alternatives for end-of-life care."

THE FACTS: The bill would require Medicare to pay for advance directive consultations with health care professionals. But it would not require anyone to use the benefit.

Advance directives lay out a patient's wishes for life-extending measures under various scenarios involving terminal illness, severe brain damage and situations. Patients and their families would consult with health professionals, not government agents, if they used the proposed benefit.

CLAIM: Health care revisions would lead to government-funded abortions.

Tony Perkins of the Family Research Council says in a video, "Unless Congress states otherwise, under a government takeover of health care, taxpayers will be forced to fund abortions for the first time in over three decades."

THE FACTS: The proposed bills would not undo the Hyde Amendment, which bars paying for abortions through Medicaid, the government insurance program for the poor. But a health care overhaul could create a government-run insurance program, or insurance "exchanges," that would not involve Medicaid and whose abortion guidelines are not yet clear.

Obama recently told CBS that the nation should continue a tradition of "not financing abortions as part of government-funded health care."

The House Energy and Commerce Committee amended the House bill Thursday to state that health insurance plans have the option of covering abortion, but no public money can be used to fund abortions. The bill says health plans in a new purchasing exchange would not be required to cover abortion but that each region of the country should have at least one plan that does.

Congressional action this fall will determine whether such language is in the final bill.

CLAIM: Americans won't have to change doctors or insurance companies.

"If you like your plan and you like your doctor, you won't have to do a thing," Obama said on June 23. "You keep your plan; you keep your doctor."

THE FACTS: The proposed legislation would not require people to drop their doctor or insurer. But some tax provisions, depending on how they are written, might make it cheaper for some employers to pay a fee to end their health coverage. Their workers presumably would move to a public insurance plan that might not include their current doctors.

CLAIM: The Democrats' plans will lead to rationing, or the government determining which medical procedures a patient can have.

"Expanding government health programs will hasten the day that government rations medical care to seniors," conservative writer Michael Cannon said in the Washington Times.

THE FACTS: Millions of Americans already face rationing, as insurance companies rule on procedures they will cover.

Denying coverage for certain procedures might increase under proposals to have a government-appointed agency identify medicines and procedures best suited for various conditions.

Obama says the goal is to identify the most effective and efficient medical practices, and to steer patients and providers to them. He recently told a forum: "We don't want to ration by dictating to somebody, 'OK, you know what? We don't think that this senior should get a hip replacement.' What we do want to be able to do is to provide information to that senior and to her doctor about, you know, this is the thing that is going to be most helpful to you in dealing with your condition."

CLAIM: Overhauling health care will not expand the federal deficit over the long term.

Obama has pledged that "health insurance reform will not add to our deficit over the next decade, and I mean it."

THE FACTS: Obama's pledge does not apply to proposed spending of about $245 billion over the next decade to increase Medicare fees for doctors. The White House says the extra payment, designed to prevent a scheduled cut of about 21 percent in doctor fees, already was part of the administration's policy.

Beyond that, the nonpartisan Congressional Budget Office said the House bill lacks mechanisms to bring health care costs under control. In response, the White House and Democratic lawmakers are talking about creating a powerful new board to root out waste in government health programs. But it's unclear how that would work.

Budget experts also warn of accounting gimmicks that can mask true burdens on the deficit. The bipartisan Committee for a Responsible Federal Budget says they include back-loading the heaviest costs at the end of the 10-year period and beyond.

Copyright © 2009 The Associated Press. All rights reserved

By Bellafia
Posted August 2, 2009 at 6:19 pm
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With all due respect Kennarina I researched and found these 2 articles and down loadded them. I do not want to make this a place where politics take presidence on this great site, so this will be the last time i will comment on this crucial issue. I did not highlight anything on this article, that was done by the author.

The Downside of a ‘Public Option’: Oregon’s Physician-Assisted Suicide Promotion and Overall Rationing of Care

Posted by Jeff Emanuel (Profile)

Friday, July 24th at 4:35PM EDT

14 Comments
If you haven’t, read Erick’s post about an Oregon public health plan (”public option”) administrator responding to a cancer patient’s request for subsidized chemotherapy with a denial of treatment but an offer to fund a physician-assisted suicide.
Now, know this: over the course of this decade, the state of Oregon has put in place a formal procedure for rationing care to patients whose health coverage is subsidized by government (i.e., who are enrolled in some form of the state’s “public option”). To date, they are the only government in the world to have formally done this, though many — from Britain to Canada to states here in the U.S. — work “cost-effectiveness” into their official denials of medical treatment.
After beginning the process of determining the cost-effectiveness (to the state) of hundreds of medical treatments and procedures in 2002, the Oregon Health Services Commission narrowed down the number they were willing to entertain offering coverage for to 680, ranked in order of state priority. This year — 2009 — the state will only reimburse physicians for performing procedures and offering treatments ranked in the top 503, in ascending order of priority.
Recipe for Denial of Care
WHAT THIS MEANS, of course, is that a patient enrolled in the “public option” who was in need of a treatment or procedure the commission decided to rank 503rd or below in priority would be ineligible for that procedure — period. Further, state bureaucrats balancing Oregon’s figurative checkbook could decide that the Beaver State only had enough health care dollars to fund some of the procedures on the list. This is where the prioritization comes in: under the state’s rationing procedure, a person in need of an emergency appendectomy (prioritized 84th by the the state of Oregon) would be denied that treatment before an individual in need of treatment for “tobacco dependence” (ranked 6th).
Does that sound a bit perverse to you? How about this: the state rationing board ranked abortion 41st overall in state-funding priority, meaning the bureaucrats who designed the priority structure in this “public option” program determined that the use of taxpayer funds for abortion is more important (and more medically necessary) than covering injuries to major blood vessels (ranked 86th), surgery to repair injured internal organs (88th), a “deep wound to the neck” or open fracture of the larynx or trachea (91st), or a ruptured aortic aneurysm (306th).
Also of note is the fact that treatment for esophogal, liver, and pancreatic cancers take up priority slots 337 through 339, with treatment for stroke at 340 — all over 300 places behind Obesity (8!), Depression (9), and Asthma (11).
That Pesky “Prolonging of Life Issue”
In the “Intent” section of the state’s rationing guidelines, the bureaucrats responsible for the prioritization and denial of care make clear their view on end-of-life treatment and treatment for the chronically ill. It is, in a nutshell, “make them comfortable, but do not extend lives” — because these bureaucrats have determined, apparently, that the state’s “public option” health care dollars need to be saved for use on the healthy (or the tobacco-addicted), rather than on those who desperately need them.
From the report:
It is the intent of the Commission that comfort/palliative care treatments for patients with an illness with <5% expected 5 year survival be a covered service. Comfort/palliative care includes the provision of services or items that give comfort to and/or relieve symptoms for such patients. There is no intent to limit comfort/palliative care services according to the expected length of life (e.g., six months) for such patients, except as specified by Oregon Administrative Rules.
That all sounds fine and dandy — until you get to the fine print (page 97 of the 143-page rationing guide), where what is and isn’t covered is listed. What is covered includes:
1) Medication for symptom control and/or pain relief;
2) In-home, day care services, and hospice services as defined by DMAP;
3) Medical equipment (such as wheelchairs or walkers) determined to be medically appropriate for completion of basic activities of daily living;
4) Medical supplies (such as bandages and catheters) determined to be medically appropriate for management of symptomatic complications or as required for symptom control; and
5) Services under ORS 127.800-127.897 (Oregon Death with Dignity Act), to include but not be limited to the attending physician visits, consulting physician confirmation, mental health evaluation and counseling, and prescription medications.
And, more importantly, what is not covered:
1) Chemotherapy or surgical interventions with the primary intent to prolong life or alter disease progression; and
2) Medical equipment or supplies which will not benefit the patient for a reasonable length of time.
“Reasonable length of time” is, of course, an arbitrary measure left entirely up to the bureaucrats counting the change in that year’s budget. In other words, if everybody in the state with all 503 conditions has been treated (in order of priority, of course) and there is money left over in the “public option” cookie jar, then a “reasonable length of time” that drugs or treatments would benefit a patient may be defined as a bit longer than it would be if there weren’t enough funds to go around for those whose illnesses and conditions qualify them for preferential treatment under the state’s official rationing policy.
Either way, folks’ health care — and, ultimately, length of life — is being left up to state bureaucrats.
Politics and Medicine Make Poor Bedfellows
State administrators say they chose to focus on “less costly” preventive care (whose money-saving bona fides are dubious at best) when devising the state’s rationing program, rather than on medical conditions and emergencies in hopes of saving more money in the long run. However, much like the often-ridiculous mandated coverages on state health insurance policies that serve to drive up health insurance costs across the country, the determination of what will be covered and where it falls in the priority list was heavily influenced by special interest groups that have the ear of state government officials and cost-effectiveness-regulating bureaucrats.
In other words, this politician-run medicine has fallen victim to…politics. As the Pacific Research Institute’s indispensable John Graham posted yesterday on Twitter, “the best way to keep politics out of medical decisions is to keep politicians out of medical decisions.”
Oregon residents like Randy Stroup are finding that out the hardest way possible. Despite the President’s persistent push to remake America’s health care system in Oregon’s image, we as a nation can’t afford to learn the same lesson as Oregon the hard way.

By Dan Springer

PORTLAND, Ore. — Some terminally ill patients in Oregon who turned to their state for health care were denied treatment and offered doctor-assisted suicide instead, a proposal some experts have called a "chilling" corruption of medical ethics.
Since the spread of his prostate cancer, 53-year-old Randy Stroup of Dexter, Ore., has been in a fight for his life. Uninsured and unable to pay for expensive chemotherapy, he applied to Oregon's state-run health plan for help.
Lane Individual Practice Association (LIPA), which administers the Oregon Health Plan in Lane County, responded to Stroup's request with a letter saying the state would not cover Stroup's pricey treatment, but would pay for the cost of physician-assisted suicide.
"It dropped my chin to the floor," Stroup told FOX News. "[How could they] not pay for medication that would help my life, and yet offer to pay to end my life?"
The letter, which has been sent to other terminal patients throughout Oregon, follows guidelines established by the state legislature.
Oregon doesn't cover life-prolonging treatment unless there is better than a 5 percent chance it will help the patients live for five more years — but it covers doctor-assisted suicide, defining it as a means of providing comfort, no different from hospice care or pain medication.
"It's chilling when you think about it," said Dr. William Toffler, a professor of family medicine at Oregon Health & Science University . "It absolutely conveys to the patient that continued living isn't worthwhile."
In issuing their latest Prioritized List of Health Services , state officials reported a new emphasis on preventive care and cost effectiveness. Dr. John Sattenspiel, LIPA's senior medical director, defended the measures.
"I have had patients who would consider knowing that this is part of that range of comfort care or palliative care services that are still available to them, they would be comforted by that," Sattenspiel said. "It really depends on the individual patient."
Toffler called it a callous practice that went against medical convention. "It corrupts the consistent medical ethic that has been in place for 2,000 years," he said. "It's absolutely breathtaking."
Oregon is the only state to legalize doctor-assisted suicide, which came into effect in 1997. Since that time, there have been 341 reported cases where doctors provided lethal doses of medicine to patients to end their lives.
Oregon voters have upheld the "Death with Dignity" law three times, and Sattenspiel says it is the state's duty to inform patients of all their legal options.
For Stroup, however, suicide was never an option. He fought back, and the Oregon Health Plan eventually reversed its decision and is now paying for his chemotherapy, giving him hope he'll be around a little longer for his 80-year-old mother and five grandchildren.

By laurahc
Posted August 2, 2009 at 8:54 pm
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THANK YOU, Kennarina. You said it so much better than I could. I am fed up with the fear-mongering and outright lying that surrounds our current health care debate.

-Laura

By martzj
Posted August 3, 2009 at 11:29 am
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Kenna,

THANK YOU! For this very clear description of what we ALL need to sit down and get started doing if we haven't done so already.

"How do you want to die?

A 'living will' or 'advance directives' are legal tools to help you inform your care providers what you want, no matter how that looks or WHAT YOUR FAMILY WANTS. If for example, you're worried that your family is going to somehow pressure you into signing up for assisted suicide - if it's legal in your state - because you're a burden, then SIGN YOUR DIRECTIVE today, outlining what you DO want instead! "

Ladies,

Kenna is 100 percent correct on this one. It is up to you to collect your STATE medical directive forms (probably easy to download from your state website. Also check out SuzeOrman.com...she has many free forms there and loads of great advice for women looking to get their financial and personal will/trusts in order).

I have a MEDICAL DIRECTIVE statement that includes MY wishes about end of life treatment. There is no way in heck I would leave this huge burden to my beloved family to make. This is the 21st century and we all have access to computers in some fashion. Libraries have computers and classes to show you how to use them to do simple research. It may seem intimidating at first, but it is really fun and freeing to learn how to sit down at a computer and begin searching for information on any subject you wish.

Written draft directives are a great way to begin. Find a private place to jot down your feelings and thoughts on what you do wish and what you do not want. For example, if you don't want to be hooked to breathing machines WRITE THAT OUT. This may take many tries. It is hard to look this stuff in the eye and just decide. Do it anyway. It is a true gift to yourself and your loved ones. Remember, we are talking about end of life only. Do you want to be hooked up to a respirator (tube inserted into nostril down throat to lungs) or do you want to be left alone and let nature take its course with hospice in attendance or family nearby. My dad chose hospice and was able to die at home (73) in peace.

My ADVANCE MEDICAL DIRECTIVE is a single page document that states I want no heroic measures taken, no tubes and machines. It includes the name of the person who will have POWER OF ATTORNEY (be my spokesperson and legal power) on my behalf from that point on. I included post-mortem instructions to spare my family those decisions too.

Maybe it would be helpful to someone to share what I made myself put into place at age 35, when I understood I was getting very sick but my doctors weren't getting it. (The YOUNGER you purchase, the lower your premiums forever).

1- Life TERM insurance policy for maximum allowed at that time (policy for 5 x annual income) to protect family. At 35, I was offered a large policy at barely $150/yr. 'Term' means the policy expires at 70, is meant to protect your family income if you die during your prime working years and IS NOT TAXABLE TO BENEFICIARIES. They recieve payment immediately upon receipt of death certificate. (Order 8 or more copies to send off to all accounts, etc.)

WHole Life policies are payable upon your death but the premiums are much higher from the beginning and one can end up paying ridiculous amounts as rates increase yearly. This is money you and family could be using right now. Whole life premiums can run up to $600-thousands a month. My term life premium has only increased to ~$30/mo over 19 years.

- Living Will. This is a wonderful document. 'Living' means that it is just a notarized document until you die, then it is activated and whatever you chose goes into effect. You can tear it up at any time if you want, change it every other day (but every new change must be notarized) if you want.

- RLT. Revokable Living Trust. My favorite. This is a 'containter' that holds your ADVANCE MEDICAL DIRECTIVE, POWER OF ATTORNEY, POUROVER WILL, TRUST DIRECTIVES. An RLT (free sample forms on-line at suzeorman.com) just means you have a nifty saftey net in place for your family because this TRUST means your affairs by-pass the courts, are completely private and your instructions will be carried out as soon as death certificate is provided to the law office holding your trust. Again, it is an 'empty legal container' while you are alive and can be changed or destroyed at any time you wish.

Copies of Living Wills and Advance Medical Directives should be carried to every hospital procedure with you and follow hospital protocol to have it put on record for all doctors to access.

DNRs (Do Not Resuscitate), medical directives and living wills can be stuck to the frig for EMTs/family to easily get to in emergency. Seeing a DNR stuck to the frig helps family members grasp what it truly is that you want to happen at the end of life. They can grab the DNR and show it to EMTs who then make a decision. DNR also means you don't call 911 anymore. It is time for nature to run its course. Hospice may be contacted for palliative end of life care.

This is the best we can do....we can make the time to have these deep heart conversations with ourselves, write them down and turn them into legal documents to protect our end of life rights and our families. Medical personnel may override directives and families may fight your directive wishes. Your prepared legal documents may help you when you no longer have the strength for decisions.

Get started on these documents, have them legally validated and forget about them. Enjoy your life!

By martzj
Posted August 3, 2009 at 4:55 pm
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President OBAMA 'has a doctor following him around 24/7' as he puts it. The president and governing bodies must have protective gold standard health care, just as they are taken swiftly to secret safe locations during attacks.

Obama has always been a proponent of the general US population having access to the same gov't health insurance as Congress. It isn't working out that way at this time, but there is no universal health agreement on the table yet. I'm going to be optomistic.

Jaynie

By Winglover
Posted August 3, 2009 at 4:57 pm
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Kenna & Jaynie:
Wow! Couldn't have said it better. You do not know how much of the lay public do not fully understand this subject. Being an ICU nurse this comes up daily. It is something that needs to be discussed. If your loved ones or your wishes are not truly known it is a tremendous amount of stress for families. I have dealt with this myself with both my parents. People do not really realize what "do everything" means. Make sure EVERYONE knows what you want. I have witnessed many a war between siblings when it's Mom or Dad's time. Thank you ladies as always!
Lisa

By martzj
Posted August 3, 2009 at 5:53 pm
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Lisa,

I was driving my sister a few weeks before dad died and she said, "Wow, I just never know when to call 911?"

"We don't call 911 any more sis. There's a DNR stuck to the frig now. That's the way he wants it." She didn't really get it until that moment. It felt strange to me too but it was so important.

I do feel for you nurses and doctors having to deal with families who've had no time to prepare in advance like we did.

How did your son's cardio visit go? If you feel like sharing.....

take good care,
Jaynie

By Winglover
Posted August 4, 2009 at 12:55 am
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Jaynie,
It is very hard to witness a family member trying to "do the right thing". Having lost both my parents in an ICU setting it does give me a whole new way of dealing with it. My mother was totally unexpected. We had to remove her from life support. My father made his own decisions after going through "the lets try everything" approach when he had finally had enough. He knew it was his day and said " no more". It was not easy or pretty.
As for my son.....we did get some positive news. His heart has decreased in size and the ventricles do squeeze somewhat rather than just twist. Guess the Coreg is helping huh? And finally his Mitral valve does not leak. Really no change in is EF from 20% Big bummer. I so wanted to hear it had increased. It's been 14 months. He was thrilled to hear there are no plans for a pacemaker or ICD. Unless he has episodes of fainting or tachycardia. Lord help me now I'm scared. Also told he must swim with an adult at all times which freaked him out. We make a terrific pair. I thank you for asking about him and remembering he had a visit to the transplant clinic.

Lisa

By Kennarina
Posted August 4, 2009 at 1:19 am
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Winglover, good news (albeit not GREAT news!) from your son. Hang in there....

Bronte, THANK YOU for posting the Associated Press fact checking article. What a useful tool for assessing what's truth and what's trash. Here is the link again for those who haven't read this yet:

http://www.google.com/hostednews/ap/article/ALeqM5g5ewCvsGcSPBeHJurb6qYZLVU 8OgD99QQ2OG0

This should be required reading for all Americans. Please forward this link to all your friends and family. It makes sense.

XOXOXO

http://www.myheartsisters.org

By Bellafia
Posted August 4, 2009 at 5:24 am
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Sorry I'm breaking my promise, but as I read this over again questions popped in my head.
and may place seniors in situations where they feel pressured to sign end of life directives they would not otherwise sign.

What may happen to the one I have already signed, will it stand up in a court of law?
If this bill passes the way it is will my directive become null and void?
I'm really concerned about this or am I making much ado about nothing?

“Section 1233 of the House-drafted legislation encourages health care providers to provide their Medicare patients with counseling on ‘the use of artificially administered nutrition and hydration’ and other end of life treatments, and may place seniors in situations where they feel pressured to sign end of life directives they would not otherwise sign

By martzj
Posted August 4, 2009 at 8:49 am
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"As for my son.....we did get some positive news. His heart has decreased in size and the ventricles do squeeze somewhat rather than just twist. Guess the Coreg is helping huh? And finally his Mitral valve does not leak. Really no change in is EF from 20% Big bummer. I so wanted to hear it had increased. It's been 14 months. He was thrilled to hear there are no plans for a pacemaker or ICD"

Lisa,
This is uplifting news...that the mitral is no longer leaking is a very good sign...as is the decrease in heart size. EF 20% may improve....and there are significant organ transplant breakthroughs already in test stages. THere is so much to look forward to. It is comings!! Great to hear he's been in the water!

Give yourself a hug from me. Mom needs a worry break!!! : )

Jaynie

By Winglover
Posted August 4, 2009 at 7:32 pm
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Kenna & Jaynie:
Thanks! I admit that I am a worrier. My break is returning to work. I get away from constantly looking at my son and focus on my patients instead. Stressful, but at least it takes my mind off him for awhile. We are lucky he is young and was an athlete before he was diagnosed. Gives us time for all those brilliant scientists to find a way to fix him! And yes, he loves the water!
Lisa

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