Local providers discuss end-of-life decisions

Presentation of options, planning, legal concerns

PORT ANGELES — Talking about your end-of-life wishes could be the toughest conversation you ever have with a partner, a child or a loved one, but it’s necessary if you want to exercise control over the care you receive and how it is administered.

“How you advocate for your own needs and wants in medical care is important and makes a huge difference in what type of care you get,” said Cassa Sutherland, client services manager with End of Life Washington, a nonprofit advocacy and support organization.

She joined local health care providers on a panel about end-of-life choices presented Feb. 26 by the League of Women Voters of Clallam County at Peninsula College’s Little Theater. The 255-seat space was about two-thirds full.

Norma Turner moderated the panel featuring Sutherland; Dr. Paul Cunningham, chief medical officer at Jamestown Family Health; Dr. Joshua Jones, chief physician officer at Olympic Medical Providers; and Sandy Ulf, a former hospice R.N. and a certified end of life doula.

When it comes to making decisions about the end of your life, you need to start planning and preparing now if you haven’t already, Sutherland said. The risk in not doing so might mean receiving medical treatment you don’t want, having people you don’t know or wouldn’t have chosen determining your care or losing control of how you want to die.

Start by thinking about what is important to you, she said.

“Ask what does living well mean to you and how do you define quality of life,” Sutherland said.

To ensure that your wishes are followed, you should have advance directives that put into writing the kind of medical care you want if you are unable or no longer able to communicate them, Sutherland said.

These include:

• Durable power of attorney for health care: you designate the person you want to make health care decisions if you are unable to.

• Health care directive (also known as a living will): describes your general wishes for end-of-life care.

• Do-not-resuscitate (DNR): Instructs emergency responders and health care providers that you don’t want to be resuscitated in a medical emergency.

• Physician Orders for Life-Sustaining Treatment (POLST): For individuals with serious health conditions it specifies what treatments you do or don’t want in a medical emergency.

Cunningham said that just as important and useful as advance directives were the conversations you had with the person you delegate to be your surrogate to make decisions about your care if you can’t. Make your wishes clear and make sure the surrogate agrees to follow them, he said.

“If you are laying in a hospital bed and are alert and can communicate with your provider, we’re going to ask you what do you want us to do given the circumstances,” Cunningham said.

“When you cannot do that, then we’ll turn to them [the surrogate]. And regardless of what your [directive] says, your delegate could say something else. So choose wisely.”

Individuals in Washington state also can choose how they want to spend their final days. They can stop treatment at any time, or voluntarily stop eating and drinking. They can opt for hospice or palliative care or medical aid in dying (MAID).

Ulf said even though people on hospice have a much better quality of life, if they haven’t made their wishes known, they aren’t able to take advantage of it.

“Most people join hospice way too late in their disease and don’t really benefit nearly as much as they could,” Ulf said. “They wait until their condition is so desperate that they’re on hospice for two days, five days, and we really want to think about hospice much earlier in our disease trajectory because it helps you live better.”

When it comes to medical aid in dying, even if you just think you might want to consider this option, you need to start talking about this with your physician, family, friends, or religious or spiritual confidant.

Washington voters in 2008 approved a ballot initiative that gave terminally ill patients the right to have a physician prescribe lethal drugs to hasten their death. Patients choose if or when they want to take the drugs, which are self-administered. The physician does not administer them.

Sutherland said that very few people in Washington state have actually chosen this option; last year about 350 people — of less than .3 percent of deaths in the state — made that decision.

Whatever decisions you need to make about your end-of-life care, the panel agreed, don’t go about it alone.

“Talked to your loved ones,” Cunningham said.

“Talk to all the people who care about you,” Ulf said.

Cassa Sutherland’s presentation, “End of Life Ready,” can be found at tinyurl.com/yc4ume84.


Reporter Paula Hunt can be reached at Paula.Hunt@soundpublishing.com

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