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Health & Fitness

Having "The Conversation": Talking About Your Medical Choices At Thanksgiving

Since 2008 there has been an effort to nudge families to share their feelings about medical and end-of-life issues during the Thanksgiving dinner.

Nobody wants to talk about medical issues at Thanksgiving. However, since 2008 there has been an effort to nudge families to share their feelings about medical and end-of-life issues during the Thanksgiving dinner. There is both practical and a legal reason for doing this. 

On a practical level, Thanksgiving is a perfect time to discuss your feelings about medical and end-of-life issues. Family and/or friends are gathered in one place, we have more than the usual amount of time to spend with each other, and the dinner table becomes a sacred spot for sharing feelings and ideas.

Although we’re technologically more advanced than the Pilgrims and Native Americans who celebrated the three-day Thanksgiving feast in 1621, the mortality rate still holds steady at 100 percent.

An organization known as Engage With Grace started operating in 2008. Their mission is to encourage families to have “the conversation” about end-of-life choices, no matter how uncomfortable it may be to begin. They feel the holidays are a perfect time to start that conversation. The Engage With Grace website contains a downloadable one-slide presentation. On the slide are five questions designed to start the difficult conversation. The web site also offers many other resources, including statistics that help to explain why end-of-life care should not be left to chance.

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If there is no advance medical directive available, a physician will usually honor the wishes of a family. That may have undesired outcomes. Without direction, children feel obligated to make every effort to save the life of a parent, not realizing that causes discomfort and distress, and will be fruitless anyway.

In the absence of direction, medical personnel will keep the life support equipment connected. The reason is simple, there are no legal consequences for “wrongful life” but there are consequences for “wrongful death.” According to my wife, a gerontological nurse practitioner, who has firsthand experience, there are even a few physicians who do not like hospice because they lose control over a patient’s care. If there is no advance medical directive, they refuse to allow a nursing home resident to spend their last days in the comfort of hospice.  

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I mentioned earlier that the standard for determining whether or not artificial life support will be sustained is the wishes of the person receiving treatment. Having an advance medical directive is the ideal way to spell out your wishes. Even if you do not have that document, testimony from others about your desire is relevant. Should a dispute about end-of-life care wind up in court, testimony about what that person said during the thanksgiving meal is what the court wants to hear. So, let your wishes be known.

Did you know that Pennsylvania now has a POLST form? This is better than an advance medical directive and we’ll talk about that in future posts. 

Enjoy the holiday and stay well until the next post.

-Bob Gasparro

Robert Gasparro is an Elder Practitioner (an accountant and attorney). He can be reached at robert.gasparro@lifespanlegal.com. He welcomes questions, or ideas for future blogs.

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