oining the Medical Order for Life Sustaining Treatment (MOLST) initiative, Maryland has implemented this new form that a physician or nurse practitioner completes that indicates a person’s wishes in respect to life-sustaining treatments, according to a Baltimore Sun interview with Dr. Barbara Carroll, MD, the medical director at Broadmead, a senior living community. Other states that provide MOLST guidelines are New York, Massachusetts and Delaware.
Good old Earl Blumenauer. A bespectacled and bowtied Congressman from Oregon. He of the “death panel” proposal. Thank God he’s still here. Presuming that the crazy talk over the provision in the Affordable Care Act that would have paid doctors to discuss end-of-life issues with patients is over, he has introduced a separate bill with this provision and hopes to get it passed in the next couple of years.
Talking about death — even thinking about death — is uncomfortable for patients and families. Nearly 80 percent of us would prefer to spend our last days at home, but the majority of us will die in the hospital, and only 20 percent of us have expressed our wishes in writing.
In theory, or in a more perfect universe, our family members wouldn’t have a hard time deciding what to do when we were near death. However painful the task, the decisions would be clear: We would have prepared a written document, an advance directive, stating what we wanted doctors to do or not do, and our about-to-be survivors would follow our instructions. Simple.
Participants’ reactions to expert-endorsed discussion components varied. Most would feel uncomfortable receiving a doctor’s recommendation about CPR.
Women are more likely to receive early DNR orders after ICH than men. Further prospective studies are needed to determine factors contributing to the sex variation in the use of early DNR order after ICH.
Clinicians use the DNR order not only as a guide for therapeutic decisions during a cardiopulmonary arrest but also as a surrogate for broader treatment directives. Most clinicians believe that DNR discussions should take place earlier than they actually do. Interventions aimed at improving clinician knowledge and skills in advance care discussions as well as the development of orders that address overall goals of care may improve care for children with serious illness.
The understanding of terminal cancer varied among the 4 participant groups. It was associated with different preferences regarding end-of-life issues. Standardization of these terms is needed to better understand end-of-life care.
Conclusions: Problems in implementation of ACPs are multifactorial and not necessarily due to deliberate nonadherence by health professionals. Potential solutions to improve the clinical impact of ACP are discussed.
This brings to mind that all of us have a responsibility to have a plan in place for the care of our pets if some calamity happens to us. Each of us should make some kind of arrangement for the care of our animals in a will, estate plan, or in a verbal agreement from a friend that someone will watch out for them should anything happen. This is not pleasant to think about, but it is a responsibility as a pet guardian.