One of the sick ironies of “pro-life” activism opposing abortion and euthanasia is that, if such self-identified advocates are successful in obtaining their goals, not only do more people suffer and die, but there is more of the behavior “pro-lifers” abhor. Ban abortion, and women die from illegal ones. Ban various contraceptives because you feel (erroneously) that they cause abortions, and the result is more unwanted pregnancy — and more abortion. Ban good sex education, same result. Prohibit even talking about the “right to die” with doctors, and people take it into their own hands, often before they might otherwise want to, and often with bad results.
Back when I was still naive enough to debate “pro-life” anti-abortion advocates, I would repeat, over and again, “If you too truly want to decrease abortion, spend all your time and money supporting Planned Parenthood and other such places, and getting young women in there for education and contraception, and you'll finally see some results!” But they somehow never agreed, as it's easier and perhaps more fulfilling to preach righteously about the topic. Yet the evidence is clear, and most recently bolstered by new numbers showing abortion has declined in recent years — due to increased use of contraception, and not due to anti-choice activism or policies, as those have never helped move us towards the shared goal of decreasing unwanted pregnancy and abortion. I actually believe he “pro-life” movement has caused more abortions than they've prevented. For some reason they don't like that opinion.
At the other end of life, the scenario is often similar. Outright hastening of death is forbidden, but it happens all the time, clandestinly or under other names. But one of the best ways to prevent prolonged suffering leading up to death is to have open advance discussion with one's doctors — and to document those wishes. Yet remember Sarah Palin, and her “death panels"? Beyond lingering jokes, her (and her fundamentalists colleagues') lasting legacy to date is the gutting of health reform policies to allow paying physicians to take the time for the long and often difficult talk about end-of-life care and limits thereof. I know nobody in medicine, even “conservatives,” who feel that her contribution was a positive one. But until the perverse payment disincentive to talk about mortality is corrected, there are still some practical tips that can help
Nobody gets out of here alive — we all eventually die. But we don't like to talk about that and usually don't, even with our doctors. A recent survey of “end of life” attitudes and practices among California adults reveals that while 82 percent believe that it is important to have wishes about end-of-life care in writing, only 23 percent have done this; 47 percent would like to have “the conversation” about dying with their physician (61 percent of those over 65); and 70 percent would like to die at home, but this occurred in only 32 percent of deaths in 2009.
There has been some slow improvement here. As recently noted by the editors of the New York Times: “Fortunately, advance planning for end-of-life decisions has been going on for years and is continuing to spread despite the demagogy on the issue in 2009. There is good evidence that, done properly, it can greatly increase the likelihood that patients will get the care they really want. And, as a secondary benefit, their choices may help reduce the cost of health care as well"
One of the advances the Times recommends is a relatively new tool called POLST — a “Physician Orders for Life-Sustaining Treatment” form. It's another type of medical/legal “advance directive” that can give you, and your loved ones, more input in how you are treated — or not treated — when gravely ill, even if you can no longer express your wishes. A difference from those older forms is that this is an actual medical order that goes into your medical chart — increasingly an electronic one that will follow you wherever you might need care. Doctors often recommend it too, once they learn about it, and there is a concerted effort to spread awareness about POLST around the nation. It can allow you and your -- or any — doctor to act in according to your preferences for medical care as you are dying.
A physician friend who just dealt with the death of his father told me this: “When it came time for my family to discuss end-of-life care issues for my father, the POLST framework was invaluable. It greatly facilitated early and useful dialogue and allowed us to come to a very comfortable consensus despite a longstanding history of disagreement over his earlier long-term care issues."
The California POLST site is www.capolst.org. It includes the form itself (the sample printed here is just the first of two pages; it also should be printed on a specified color paper, which leads to POLST often being referred to as “that bright pink thing"). Other states have their own sources — unless they've been blocked by the boogeyman of “death panels” and the like. Some states also allow some nurses to fill out the form with you — and we've tried to get that policy adopted here in California, but not quite yet — but however it's done, it's worth it. (Those who live in a state other than California can check their options at:
www.ohsu.edu/polst/programs/state+programs.
If you do not live in California and your state does not (yet) have a POLST option, consider documenting your preferences using other forms, like a living will, durable power of attorney for health care, and the like. You can learn more about those here at coalitionccc.org. And talk with your doctor and other caregivers, and your loved ones, about this, even if you don't fill out the documents. Many major hospitals now have a fulltime person whose role is to desperately try to find some family member or friend or anybody who might speak to what a severely ill patient might have ever mentioned, even in passing, about what they might want done if they wound up in a hospital, gravely ill — often without success. The “default” is to keep on trying all sorts of extreme measures — surgery, ventilators, tubes down your throat, pounding on your chest — to revive you even when there is little chance of success and big chance of more pain, distress, and cost. I've seen it many times. That's no way to go. I can tell you from many experiences in many places that you'll be doing everybody a favor, including yourself, if you make your wishes known beforehand. And — without a death panel in sight!
As for the ongoing debate about the “right to die” and legalization of “assisted suicide” by physicians or others — more on that later. For now, if you take all the steps available to prevent such a need, you'll be ahead of the curve. But still not quite immortal.
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