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End of Life: A quiz to end all quizzes

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Q: What is palliative care?

A: Pain and symptom control, as opposed to other medical procedures. Also used in a wider context to include additional supportive services — counseling and spiritual support, for instance — for people with life-limiting illness, including those receiving aggressive treatment.

Q: What is hospice?

A: Voluntary end-of-life care for patients referred by doctors. Can take place at home or in a hospice facility; includes palliative care and services for caregivers and grieving families. Does not include extreme medical measures to prolong life.

Q: Is hospice a place where people go to die?

A: Hospice care is for patients at or near the end of life who do not wish to have extreme medical interventions to keep them alive.

A third of patients served by Community Hospice in Longview die at home or at the hospice facility with palliative care from nurses: their needs are met and they are kept free of pain. Another third receive respite care — supportive services for caregivers. The final third are seriously ill people who receive symptom management from nurses who visit to monitor and alleviate pain.

Q: Do some patients go to hospice and then go home?

A: Yes. Patients stay "on hospice" for 90-day periods, receiving palliative care and being monitored. Those who rebound — as many do — go back to regular medical care.

Q: How do patients pay for palliative care and hospice?

A: It is covered by Medicare, Medicaid and most private insurances. Social workers at Community Hospice or St. John can help explain how this works.

Q: What are the choices do I have at the end of my life?

A: The Washington Natural Death Act recognizes the right of adults to make decisions about their own health care. According to the National Hospice Foundation, decisions that a dying patient may face include:

  • Artificial nutrition and hydration (whether or not to have a feeding tube or intravenous fluids).
  • Cardiopulmonary resuscitation (whether or not to restart a heart that has stopped).
  • Mechnical ventilation, or "intubation" (whether or not to use a machine to breathe).
  • Stopping treatment aimed at treating or curing a disease, such as chemotherapy, radiation, kidney dialysis, etc.

Q: How can I let people know what I want?

A: Adults can record their wishes about how they want to be cared for at the end of life in a variety of documents called "advanced care directives" or "directives to physicians."

  • Five Wishes — This is a widely used document that must be signed by two witnesses not related to you and in the presence of a notary. Five Wishes sets down who should make health care decisions for you if you can't make them yourself ,and spells out medical treatments you want or don't want and other preferences you have about dying.
  • Physician's Orders for Life Sustaining Treatment (POLST) — Brightly colored, one-sheet instructions on extreme medical interventions that keep people breathing, feed them or keep their hearts going. The document must be signed by the patient, health care agent, spouse/other, and physician. Ask your primary care physician about a POLST.
  • If you are in the hospital and do not wish to receive CPR, the doctor must write a "do-no-resuscitate" order (called the DNR). Emergency responders must also honor DNR orders in the form of a POLST and displayed prominently at home or in a nursing facility.
  • Talking to a spouse, close friend or relative will help them make decisions on your behalf if you lose the ability to do so, but such conversations will not stop emergency responders from doing all in their power to keep you alive unless you have a prominantly displayed POLST (see above) or DNR order. HIPAA rules, which protect patient privacy, permit disclosure of POLST information to health care providers.
  • To appoint someone who will speak for you in health care decisions if you are not able, you need a Durable Power of Attorney for Health Care. There are standard forms, but since this is a legal document, you may wish to consult with an attorney.

Q: Can I decide when I want to die?

A: Terminally ill Washington and Oregon residents may choose to die, but they must follow a rigorous evaluation process.

The Death with Dignity Act, also known as physician-assisted suicide, is voluntary and the patient must initiate the request.

A capable adult who has been diagnosed by a physician as having a condition that will end the patient's life within six months may request in writing, from a physician, a prescription for a lethal dose of medication for the purpose of ending his or her life.

Oregon passed a Death with Dignity Act in 1994. In 2009, 95 people in the state received prescriptions, 59 of them used the law to hasten their deaths and 55 physicians participated.

In 2008, the Washington state law of the same name went into effect. According to the Washington Department of Health, 63 terminally ill patients received prescriptions, 36 hastened their deaths, and 53 physicians participated in 2009.

Any physician, pharmacist or healthcare provider who has moral objections to the Act may refuse to participate. In Longview, St. John Medical Center does not participate in physician-assisted death.

For help exercising your rights under the Death with Dignity Act, including finding a physician, contact Compassion & Choices of Washington, (206) 256-1636 or 1 (877) 222-2816, or e-mail info@CompassionWA.org.

In Oregon, contact Compassion & Choices of Oregon at 1 (503) 525-1956 or contact@compassionoforegon.org

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