"Study" finds that 1 in 4 will need health decisions made for them
#1
yeah thats right

http://www.msnbc.msn.com/id/36121898/ns/...alth_care/


1 in 4 will need health decisions made for them
Those who have living wills usually get treatment they wanted, study finds
By STEPHANIE NANO
The Associated Press
updated 5:20 p.m. ET, Wed., March. 31, 2010

NEW YORK - A significant number of the elderly — more than one in four — will eventually need someone to make end-of-life decisions about their medical care, a new study suggests.

The results illustrate the value of people making their wishes known in a living will and designating someone to make treatment decisions for them, the researchers said.

In the study, those who spelled out their preferences in living wills usually got the treatment they wanted. Only a few wanted heroic measures to prolong their lives.

The researchers said it's the first accounting of how many of the elderly really end up needing medical decisions made for them.

Last year, end-of-life care became embroiled in the health care reform debate. A provision in the legislation would have allowed Medicare to pay doctors for counseling patients about end-of-life issues like living wills.

Critics labeled the counseling "death panels" and the proposal was eventually dropped before the researchers could get their report out. They had pushed to complete the study because of the national debate, but it took time to get it published, said the study's leader, Dr. Maria Silveira. She teaches at the University of Michigan and does research for Veterans Affairs.

The study is in Thursday's New England Journal of Medicine.

The researchers concluded that advance directives — living wills and health proxies chosen to make end-of-life decisions — are "important tools for providing care in keeping with patients' wishes."

The use of these directives has increased in the U.S. despite debate about their effectiveness. For the past two decades, hospitals and facilities that take Medicare patients are required to provide information on them.

A living will states a person's choices for treatment if he becomes incapacitated, but critics complain they are too vague to be helpful. A health care proxy names another person — usually a relative or friend — to make medical decisions if needed. Many people have both.

Typical decisions involve the use of breathing machines or feeding tubes or giving someone CPR.

In the study, researchers looked at how often the elderly reach the point where they can't make their own care decisions near the end of life — usually because of dementia, a stroke or a debilitating illness. They also examined how many had living wills or a proxy and the outcome.

The study included 3,746 people age 60 and older who died between 2000 and 2006. The average age was 80.

About 30 percent needed a treatment decision made before death but couldn't do it themselves. Of those, about two-thirds had either a living will, a proxy or both.

After the person died, relatives were interviewed to find out if the person's wishes were followed. Most reported that they had. Nearly all the patients had wanted limited or "comfort" care; only 2 percent wanted aggressive care.

Advance directives are available for individual states online, http://www.caringinfo.org/PlanningAhead.htm, and an attorney isn't needed, a popular misconception, Silveira said.

"We don't expect perfection out of these documents," she said. "They're there to make a difficult situation maybe a little bit less so."

The study's results, while "tantalizing," haven't convinced Dr. Muriel Gillick of Harvard Medical School that living wills are all that useful. Ideally, older patients, along with their proxy, should discuss their medical condition, goals and treatment options with a physician — instead of just signing a form, she said.

In an editorial in the journal, Gillick said the findings nevertheless "demonstrate that talking about the goals of medical care has become acceptable to a large majority of Americans who need it most."

An alternative, she said, is a program with a more detailed form that includes doctor's orders for specific care — called "physician orders for life-sustaining treatment." The program has been adopted in a few states.

One community that has embraced advanced directives is La Crosse, Wis. A citywide program grew out of the counseling experience of Bernard "Bud" Hammes at Gundersen Lutheran hospital. Hammes said he saw how distressing it was for three families who had to decide whether to continue dialysis for patients who had suffered serious strokes.

He asked them what their relative would want. "In all three cases, the family said: 'We have no idea. We never talked about it,'" he recalled.

A program called Respecting Choices is now used by the city's hospitals, nursing homes and other health-care providers. Today, most patients — 85 percent — have a care plan when they die, he said.
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#2
Soon ethics boards will be deciding that you cost too much for the state to pay for your care...you will be placed on a morphine drip and the $7/hr nurse you voted for will watch you die in your bedsores.  Hey, at least it won't hurt once the morphine gtt gets going....or will it?...she will, after all, be a $7/hr nurse.

I promise you will get what you pay for...LOL
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#3
So glad that we've got the Death Panels that Sarah Palin made up, that somehow have now magically appeared after the legislation passed to help these people along, er ... I mean help these people out.
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#4
Yep, and Paul Krugman spilled the beans on TV.
tim
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#5


obamacare can be overturned before it ever takes effect if enough people organize against it, vote out the people who voted for it and vote in people who will work to repeal it.

but the story in the OP isn't about rationing care at all.  it's about a study that found that about 30% of 3000+ people in a study reached a point at which they were unable to make decisions about their own health care and only 2/3 of that 30% had a living will or a health care proxy, meaning someone else had to make their decisions, someone who didn't know them or what they wanted.

it's not a bad thing to think ahead about what you would want to be done for you in certain situations.  personally, i think you're better off giving a medical power of attorney to someone who loves you and would decide what's really best for you in a specific situation, rather than signing a living will, which necessarily has to make broad general statements.  most people would probably say "I don't want to live on a ventilator" but if a ventilator was required for a few days after necessary surgery, most would accept it.  if you specify "no ventilators" in writing, you might not get the surgery that you need.  it's a tricky business trying to get it right. 

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#6
(04-01-2010, 01:12 PM)i.p.i. Wrote: obamacare can be overturned before it ever takes effect if enough people organize against it, vote out the people who voted for it and vote in people who will work to repeal it.

It will never be repealed. Never. Same as Social Security, Medicare, Medicaid, Roe v Wade, and on and on ad nauseum. Never.

The only thing that can stop all this and more is the financial collapse of the US government. And don't look now, but it's heading this way......
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#7
So we need a study to tell us that old age includes weakness and eventually helplessness?  We didn't know this already?  Rolling eyes
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#8
(04-01-2010, 02:00 PM)littlerose Wrote: So we need a study to tell us that old age includes weakness and eventually helplessness?   We didn't know this already?  Rolling eyes
That's okay, we also paid for a study about 20 years ago that told us that "90% of all injuries involving tricycles involve falling off." Of course, they never specified if they were talking about juvenile tricycles or the geriatric kinds ....
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#9
(04-01-2010, 01:12 PM)i.p.i. Wrote: it's not a bad thing to think ahead about what you would want to be done for you in certain situations. 

Yeah, but some days I want to be plugged in and resuscitated until they run out of drugs in the supply cabinet, other days I'm disappointed I even woke up.

I'm going to say they should check the Magic 8 Ball for me...
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#10
(04-02-2010, 12:17 PM)DarkKnight Wrote:
(04-01-2010, 02:00 PM)littlerose Wrote: So we need a study to tell us that old age includes weakness and eventually helplessness?   We didn't know this already?  Rolling eyes
That's okay, we also paid for a study about 20 years ago that told us that "90% of all injuries involving tricycles involve falling off." Of course, they never specified if they were talking about juvenile tricycles or the geriatric kinds ....

They were talking about Shriners'  parades.
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