Monday, April 19, 2010

Who is your health care proxy?

Last Thursday was National Health Care Decisions Day. As I sat around a conference table, I asked a group of colleagues how many had completed advance directives. Only about one third raised their hands! This is astonishing to me, because we are all hospice workers, we all know what we are supposed to do. And the next question: do you know where it is? brought fewer responses.

It's sad when we don't practice what we preach. It's bad enough when we are overweight and smoke, drink too much and drive too fast. But we of all people should be the poster children for having Living Wills and Medical Powers of Attorney completed. Is this like the shoemaker whose children went barefoot? Or the carpenter without a roof?

I especially like the Five Wishes forms. These are easily obtained on the website, and completed at leisure. There is no need to pay money for an attorney. I like them for their detail, which of course you can complete as much or as little as you desire. They incorporate the Living Will and the Health Care Proxy in the same form, then go on to planning your funeral. It should be noted here that I have no ties to the Five Wishes or the Aging With Dignity organization. But I applaud them for the work they have done to improve access to advance directives and increase education about them.

So how about it? Do you have yours completed? What about your family? Do you know where it is? Does your health care provider know? If the answers to any of these questions is no, you have work to do.

Thursday, April 1, 2010

Wrongful death in Hospice

Hospice patients are supposed to die of their disease, right? At least that's what I've always thought. This week I had the shock of learning that one of my patients had been found at home dead, likely due to foul play. It's not clear exactly what happened. Another family member was with him, also dead. There was talk of murder/suicide.

Processing this event has not been easy. This patient had been in and out of the inpatient facility, most recently discharged home a couple of weeks ago. At that time, he was doing fairly well with his symptoms and disease progression. He was still ambulatory, his pain was well controlled, and he was eating to his satisfaction. He knew that when his time came to die, he could return to the inpatient facility and the nursing staff he trusted would care for him. That had been his wish, to be cared for by these nurses in his final hours. His life, and his wishes, have been taken from him.

This sort of thing has never happened to me before. I don't have statistics on untimely deaths in hospice. I know that suicide occurs, but this was so obviously not suicide, at least not on the part of the patient. Are there statistics on murders of hospice patients? Has anyone else had a similar experience? I'd like to hear about it, and how you worked through it.