Another holiday season has passed. And each year, most of us are reminded of Charles Dickens’ “A Christmas Carol.” Can you remember the sour and stingy Scrooge’s final legacy, shown to him by the Ghost of Christmas Future: a cheap tombstone in an unkempt graveyard, Scrooge weeping over his own grave and begging the ghost for a chance to change his ways?
Well, in a way, Scrooge was forming his advance care plan. Bah humbug, you say? Well, Scrooge didn’t want to end up that way, so he started planning and made some changes. What does that mean for you?
Many neglect end-of-life issues—in fact less than 20% of Americans have advance directives. It is reported that most would prefer to die at home, yet three-quarters of our population die in some sort of medical institution.
As health care providers, we attempt to provide a positive environment for our patients as they approach the ends of their lives. In order to do this, we must understand and assist our patients to define their individual needs and desires. A “good death” is different for everyone, but is always one in which a person has some control, is consistent with his or her faith, is relatively free from pain, and is in a supported and dignified setting.
How do we, as health care providers, evolve towards this ultimate patient- and family-centered care? The first step is to develop our own advance care plan. This consists of both an advance directive and a designated surrogate (or agent), who knows and respects your preferences. The choosing of this agent is important because not all situations or outcomes are easily predictable. This collaboration personalizes the details of final care and comfort, allowing our loved ones to make decisions with confidence. This process will help us know how to talk to our patients about advance care planning.
Talk out your thoughts and wishes with your agent and family. Talk to your patients about advance care planning. Take it from Scrooge.