Monday, March 07, 2016

Church forum on end-of-life care issues presents "Five Wishes" and "POST" directives


On Sunday, March 6, 2016, the First Baptist Church of the City of Washington DC hosted, after the pot luck, a forum called “Stepping on Out”, by retired physician Dudley F. Rochester, MD, from Charlottesville VA.  Dr. Rochester presented, on Power-Point, his “Handbook of End-of-Life Care Issues.”  I did not find the exact document online.
  
The presentation was in two parts, A and B (not the same as Medicare!).  Part A was “Medical considerations for end-of-life care”.  The main point was that, since people are living longer, they are likely to be disabled for a longer time at end of life. After age 75, the “great age”, very sudden death from cancer, heart disease, and of course accidents, becomes less likely, and a gradual decline more probable, especially for women.  The two biggest problems are likely to be frailty and dementia.

The range of care levels includes aggressive life-saving care, through limited medical care, to comfort care, which can include palliative care.  With six months or less life expectancy, Medicare will authorize hospice care, which usually starts at home.

Rochester emphasized that it is desirable for those above the “Great Age” to avoid the ICU, or Intensive Care Unit.


The doctor mentioned that aggressive CPR on the elderly can result in rib fractures, since pressure goes two inches. He discussed tube feeding, and indicated that through the abdominal wall is often more comfortable, and is usually preferable to intravenous feeding (the “IV Critic” problem).
  
In Virginia and most other states, you have the right to discontinue treatments.
“Part B” was “Expressing, recording and communicating your wishes.”  The important concepts were naming a “health care agent”, proving an “advanced medical directive” including a living will, and providing a durable power of attorney.  The word “durable” means that the provisions are in effect if you are incapacitated.

He provided a comparison of the Virginia AMD, the FiveWishes AMD , and the POST Adjunct to Advanced Medical Directive  allowed in Virginia in 2014.

There was no discussion of how services are paid for.  Medicare doesn't pay for most custodial care (except hospice, or short term skilled care when the patient will recover). There was no mention of filial responsibility, still an obscure topic. 
  
“Stepping On Out” is also the name of a charity in the UK that produces greeting cards made by adults with learning or intellectual disabilities.

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