Planning for the End. Advance Directives or Death Panels?

How can you plan the end of your life? Death Panels! Got your attention, right? Well, although we're going to discuss death panels a little, they're not real. What are real are advance directives, and those are the topic of this week's Healthcare Triage. We're all going to die, but the best time to have a say in your end of life care is in advance.


John Green -- Executive Producer
Stan Muller -- Director, Producer
Aaron Carroll -- Writer
Mark Olsen -- Graphics

And the housekeeping:

[StephanieLuff]

I'm 27 and two years ago, I created my advanced directive form provided by my state. I got it notarized and put it in my file cabinet (hopefully someone will know to look in the "heath" file). I granted my father legal right to make decisions and let him know I was doing so (as well as verbally telling him what my wishes are). The notary gave me a crazy look being a 25-year old with an advanced directive but I don't care, you're never too young to have something terrible happen.

[laurap]

"Death panels." *jazz hands*

Excellent opening!

[JennySue]

I love this show and never miss it.
I am working as a CNA and going to school for my RN. I work in a nursing home and because of this I think I might have one of the most extensive advance directives and living wills, just have to have time to write it all down

[ShopTalks]

While Palin was completely wrong, she did raise a valid question about government healthcare in general. IF the country transitioned to a single payer system, a decision would have to be made regarding at what point in a persons life does the system ease off on expensive procedures. Should we pay for a 97 year old cancer patient who has a projected 3 months of life left to have a heart transplant? At what point in a persons life do really expensive procedures become wasteful? Can this question even be answer objectively? If the govt writes those checks, there has to be guidelines on how and when to write those checks. Someone will have to make a decision and that persons job will be VERY unpopular. One thing thats for certain is that everyone will think their own care is paramount. Its an interesting situation to consider. Dr. Carrol, would it be possible for you to do an episode on how other counties deal with this particular issue?

[lilmoomoo]

My father was diagnosed with early onset Alzheimer's and dementia three years ago. I told my mother at that time to form advanced directives as soon as possible. I am so glad we did. Earlier this year, he was declared by his physician unable to make his own decisions anymore. I truly hope my parents continue to live rich, full lives. Please, for the sake of your loved ones, please plan for their future. You never know when it will be taken away sooner than you think.

[IstasPumaNevada]

We really need to talk about death more in our society. It would help make the actual event a lot less traumatic for everyone involved.

[tessat]

When I was in my late 20s, I acted as the witness for my grandparents when they signed their advanced directives. My grandfather died in his sleep, so it wasn't an issue, but my grandmother slipped into a diabetic coma as her kidneys failed. When my mother and uncle made the difficult decision to take her off life support, I was devastated, but I knew that it was the decision which she had chosen ahead of time. She said that she did not want to be kept alive on a machine and I signed my name witnessing that she had said it. In the final analysis, it made it easier on my family and me because I didn't have to second-guess their choice.

[Zananos]

This is such an important, yet needed conversation. Families fall apart over this. even with everything in order, you must be sure your chosen person can be strong. make sure everyone is aware and on the same page as you. My family is about quality, not quantity in life, but others may not be. we've had these discussions in great depth, but this is because of what we do and what we see.

[holl]

As difficult of a topic as this is it is definitely important that everybody takes it into consideration. By filling out an advance directive it initially makes it easier for family members or doctors to come to a decision when that time comes. There are no loopholes to second guess what somebody would want because it is already filled out. It helps the person who has to make the final say feel better by knowing that is what you wanted and they are not forced to make a decision on their own and live with the consequences. Some people may have the opinion that death or certain medical decisions are not something that you can plan out, but advance directives are very well thought out and make a person really think of what they want as well as helping their family members move forward.

[photosinensis]

That reminds me: I need to talk with my doctor about creating advanced directives for myself. I'm young, but it's still something everyone should have.

[Animelily]

As a former critical care nurse, please please please get your advanced directive and choose a power of attorney. I have seen countless tragedies that could have been made easier if people had those two things together. And as much as a person wants to say "pull the plug on me" the person who actually has to decide that does not have an easy time. No one wants to be the person "that killed grandma, " but it's a whole lot easier to have something that says "this is what grandma wanted." It's no fun talking about this stuff, but it is so important to for times when it might be necessary.

"But I'm so young? Why should I bother?" Car accidents, brain embolisms, this stuff happens to young people all the time. Get it done.

[sjninja]

My Grandmother made me in charge of advance directive. Its the best and worst position to be in. I know that the choice I made was the best and right one but it takes a lot to be mentally prepared for it.

[jnzkngs]

There have always been death panels, they consist of your insurance company's claims department and the billing department of the hospital you are getting treatment from.

[grownwomanchild]

Hey Aaron! Can you do a video on the factors that affects a person's adult height other than genetics? My mom thinks the reason I'm tall but my brother is short is because I drank more milk or played more sports as a kid, but I would like to know if there is any truth to that. Thanks!

[tiasova]

Advance Directives are extremely important in the healthcare field. Get them done with now so your loved ones don't have to worry about anything when you get sick or incoherent and no longer can make autonomous medical decisions. Having them can diminish the stress that is put on someone when it comes to caring for their loved one. it is good to know exactly what you or someone else else wants to or wants not to have done to them. Having to make these kinds of decisions can be extremely difficult especially if you didn't know the others wishes. They can also uncloud your judgement if you thought things should have been a different way. These are your life decisions not yours and they must respect them. Having a durable power of attorney is even better because it is a legal document that must be filled out by you and signed by you and the other party. This will also avoid headaches when it comes to other things besides your health. Your loved ones will have enough things to worry about, make this one less thing.

[LawffleCopter]

In the title of this video, that should be a colon, not a period. I demand higher quality from this production!

[marihawley]

I'm excited for the video, my daughter goes off to college next year and I'd like to learn more about IUDs.

[eia]

The assumption appears to be that families and hospitals will acknowledge and act on the advance directive. If the family is not committed to supporting Grandma's wishes, can they override her? Who will the hospital listen to when Grandma is not able to make these decisions when the family disagrees? Whoever pays the bill?

[LordYon]

Hey Aaron- what do you think of the UK gov. rejection of the Assisted Dying bill? There were a lot of "slippery slope" arguments thrown about, but was wondering what data there were on death rates (particularly of vulnerable people) in places with legal assisted dying, like Switzerland and Oregon(?)?

[squidney]

Before watching this video I had never heard of "death panels." It seems like people would appreciate the fact that their insurance would now cover a visit to their doctor to discuss advance directives. If I were not in the healthcare field I know I would want help determining what I wanted in my advance directive. I cannot believe people are referring to this service as a "death panel." This service is not intended to have a panel of doctors decide your fate. This clause in the Affordable Care Act was implemented to help Americans make a more informed decision when it comes to making an advance directive. If you do not like the idea of making an advance directive the solution is simple, just don't make one. This clause in no way is forcing anyone to create an advance directive for themselves.