There is an old saying that there are only two guarantees in life - taxes and death. And while some of us may find ways to evade paying taxes, none of us will find ways to escape dying.
Whether it be the end of a long, fulfilled life or one shortened by illness, each of us has the power to decide how we wish to live until that time. What matters to us? This is where advance care planning becomes important. By identifying before hand what your values and beliefs are, questions like, "Will I be hooked up to a labyrinth of machines or undergo complex surgeries requiring tube feedings?" become less relevant, and the focus shifts to, "What gives my life meaning and will this intervention support it?"
So many of us say we don't want to be ventilated or fed by tube. But what if doing this would mean getting to see your kids graduate from university, play bridge or watch hockey? What if you needed a machine to help you live a meaningful life? Would you still say no?
Every day, hundreds of families across the country are faced with this same dilemma - what would mom want? How would dad react? Add to this stress the need to answer these questions in less than three minutes and in consultation with other family members and friends. Not a very pleasant thought, is it?
Advance care planning forces us to have those difficult conversations with those we love now, rather then during stressful, traumatic times. It provides patients with comfort, knowing that even when they are unable to communicate their wishes, someone they love and trust can do it for them. For family and friends, it provides peace of mind that the decisions they've made are the right ones.
So what does this all mean for the health-care system? In the U.S., the issue has become pressing for financial reasons. The soaring cost of health care is the greatest threat to the country's long-term solvency, and the terminally ill account for a lot of it. Twenty-five per cent of all Medicare spending is for the five per cent of patients who are in their final year of life, and most of that money goes for care in their last couple of months which is of little apparent benefit.
Our medical system is excellent at trying to stave off death with $8,000-per-month chemotherapy, $3,000-per-day intensive care, $5,000-per-hour surgery. But ultimately, death comes.
Almost all patients nearing the end of life know their ultimate fate. Yet they - along with their families and doctors - are often unprepared for the final stage. In a recent multi-centre Canadian study, titled ACCEPT, many elderly patients at high risk of dying had thought about and spoken with family about the types of life sustaining treatments they would want or not want, but that information had not been shared with their health-care professionals.Advance care planning can help patients and families navigate the emotional waters of living well and dying well so they can begin to say "good-bye", "I'm sorry" and "I love you" before it's too late. But advance care planning is not just for terminal, end-of-life patients. It's for all healthy capable adults. We can all benefit from having these difficult, personal conversations. They foster better communication between families and friends; forging bonds early in life that they can fall back on in their time of need.
The long-term benefits are immeasurable. Patients whose families experience trauma in the last days of their life often deal with depression long after their loved one is gone. The ripple effect is tremendous and often ignored.
Fraser Health is recognized nationally for its pioneering work in promoting advance care planning; having a formal program for eight years with monthly education and information sessions for health-care providers and the public. An Ipsos-Reid survey released in March 2012 showed that residents living in the Fraser Health region had the most positive results compared to the rest of the country.
For most of us, medicine is there to fight death and disease. We are constantly deluded by a fantasy of what medical science can and cannot do. Many of us live as if death is an option. It is time we remember that people die only once, and we need to have those hard discussions so they and their families can prepare for what is to come.
Cari Borenko Hoffman is the project implementation coordinator for Advance Care Planning at Fraser Health.
For more information, visit www.fraserhealth.ca/your_care/advance-care-planning.
