It’s time to have “the talk”

Shorewood doctor encourages the community to consider end-of-life planning

What kind of care do you want at the end of your life? If you were to be in an accident or suffer a serious medical condition, would you want to be hooked up to machines or would you want to die naturally with no intervention?

These are things nobody wants to think about. But according to Shorewood resident and Emergency Physician Ann McIntosh, choosing for yourself, ahead of time, what kind of care you want when the going gets tough is one of the most important things we can do – for both ourselves and our families.

Advance directives, legally-recognized documents that state what  medical care a person would want in various situations, allow people to decide for themselves what measures they want doctors to go to when their lives are on the line. This effectively removes the decision-making responsibility from their loved ones.

Through an advance directive, people can designate a “health care proxy,” which is someone who would speak for the person if they can’t speak for themselves, and formulate a living will that outlines what the person’s wishes are in the event they are in the hospital and in need of attention.

Advance directives can declare everything from not wanting to receive CPR to asking to be taken off a ventilator after a certain number of days.

McIntosh said as an emergency physician, she is far too aware of the number of people who have not drafted an advance directive.

McIntosh has had to have “the conversation” with families in the heat of the moment, which means the family is deciding on the spot what kind of care their loved one would want while simultaneously struggling with the emotional trauma of a scary situation.

“From an emergency perspective, I need to know right now what people want, and if they haven’t talked about it already it’s really hard,” she said.

McIntosh said it’s possible in this situation that family members may make a decision that isn’t actually in the best interest of their loved one, which could make the situation even harder to deal with in the long run – but that’s not necessarily their fault.

“Currently in our culture the default is doing something (when a person’s heart stops),” McIntosh said. “And it’s often what people don’t want. And then … once everything is done and you’re hooked up to the machines, it’s a lot harder to take people off the machines than it is to not put them on … It’s ‘pulling the plug.’”

McIntosh said people may feel like they’re taking an “active measure to end somebody’s life.” Though not all people would feel this way, McIntosh said the best way to avoid having to make this tough decision is to proactively prepare a plan before anything bad happens.

National Healthcare Decisions Day, April 16, is a nationally recognized day dedicated to encouraging people to prepare advance directives. One city that has grabbed National Healthcare Decisions Day by the horns, La Crosse, Wis., is reaping the benefits of thinking ahead.

La Crosse has been referred to as the “cheapest place to die in America,” and McIntosh credits advance directives with that accomplishment.

She said while “large quantities of the healthcare dollar are spent in the last six months (of life),” La Crosse, with 96 percent of its population having prepared advance directives, saves on healthcare expenses by avoiding providing (and paying for) care a person may never have wanted in the first place.

Shaina Goodwin, a nurse working at Deephaven Woods Assisted Living, said she is always thankful to see a client come in with an advance directive. She said anything that can help Deephaven Woods make decisions that are in the best interest of its clients is welcome.

“We try to get everyone who moves in … to have a health directive,” Goodwin said. “They are a really good go-to to know what the family’s wishes are and what the resident’s wishes are, and are especially helpful in situations where we might not know the resident’s family.”

Unlike Deephaven Woods, Minnetonka’s Sunrise Senior Living welcomes advance directives, but doesn’t make a specific push for residents to prepare one.

Still, Sunrise Area Manager Business Developer Bill Reichstadt said when residents do have them, they can be very helpful.

“We want to be able to honor their wishes,” Reichstadt said. “But sometimes people can progress really fast and unfortunately there isn’t time to (prepare an advance directive).”

How can we avoid that? By having the conversation early.

McIntosh said anyone of sound mind and body, regardless of age, has the right to decide what kind of medical care they want in the event of an emergency.

She recently brought this idea to the Excelsior-Lake Minnetonka Chamber of Commerce and was told her idea would make for a truly unique community event.

McIntosh said she hopes to bring National Healthcare Decisions Day to the South Lake area, and is making a push to kick off the movement with a “’Let’s get it started’ Community Conversation Day” April 16.

With the help of the Chamber, McIntosh hopes to draw attention to advance directives, potentially even offering forms at Excelsior-area businesses in the weeks leading up to the event.

While no details have been finalized, McIntosh hopes to have a band, guest speakers in the healthcare and financial professions available for presentations and discussion, and even people in attendance who leave the event with legally-binding advance directives.

“One of my visions for this event is to simply get the conversation started,” McIntosh said. “And if people have stories that they want to share, even anonymously, (they can) write them down and submit them to the Chamber and we can do something with them, display them or something … I really want it to be a community, multidisciplinary, not-me-just-giving-a-lecture event.”

At the end of the day, McIntosh said the advance directive conversation is an ongoing one. People’s wishes may change with age or circumstance, so she encourages families to begin discussions now and revisit the topic off and on for the rest of their lives.

For more information on National Healthcare Decisions Day or for resources to begin your own advance directive, visit nhdd.org.

For tips on how to get the conversation started, visit theconversationproject.org.

Contact Stephanie Helseth at [email protected]