Friday, November 30, 2012

It's time to have "the talk"

Please enjoy this cuteness as a reward for reading this post
No, I'm not talking about the "birds and bees" talk. This "talk" is one you should have with your parents, or your partner, not your children. It's not an easy talk. You're not going to want to talk about it. They are not going to want to talk about it. But the discussion is important, and it should take place sooner than later. This "talk" is about advance health care directives.

Essentially, establishing "advance health care directives" (sometimes called a "living will") means deciding ahead of time how you want to be treated if you are no longer able to make decisions for yourself because you are ill (for example, with dementia) or incapacitated (for example, after a car crash). These decisions include things like whether you'd want to have a feeding tube, be treated with antibiotics, or be resuscitated with CPR if your heart fails (and many other decisions!). In general, people go about this in one of two ways: either by appointing someone to make decisions for them should it be necessary, or by writing down instructions for treatment, such as the kinds of treatments they would be ok with and the kinds they wouldn't want. Ideally, the advance directives should be a combination of both.

Now you're probably sitting there thinking "I'm way too young for this" (aren't we all), or "my parents are well, there's no need". And that's exactly the problem: by the time you need advance directives, chances are it will be too late. Our ability to make decisions for ourselves over our lifetime is like a bell curve: it's pretty low when we're young, still low-ish in our pre-teen/teenage years (hence the need for the "birds and bees" talk), then it peaks in adulthood, and starts declining again as we get older. So ideally we should start this discussion at our peak. I know I'm being a complete bummer suggesting we all sit down and talk about death and illness at our peak. But there's a good chance you'll thank me later.

I'm currently attending the Leadership Program for Physicians and Leaders in Long-Term Care in Vancouver (my talk is tomorrow and I should definitely be preparing for it instead of writing this!). There's a lot of discussion at the conference around advance directives. The main problem is that a lot of people don't have them!

There's some uncertainty over how much physicians actually follow advance directives. In some areas they have to and in others they don't. Really what it comes down to is everyone is better off if they have at least had the discussion - at the conference, one presenter mentioned how older adults who have advance directives tend to enjoy a better quality of life, and a better death. I know, I know. You're don't want to be reading about death on a Friday night. If you need a break, here are some kittens: click here.

As I said before, it's not an easy discussion. "Ah, ok, so, yeah, one day I might have dementia, or be in a car accident and suffer brain damage, and well I think I'd rather...". But hey, a lot of discussions are unpleasant ("Ah, ok, so, yeah, I dropped your brand new iPhone in the toilet"). So just do it. And don't just sit down and write this by yourself, either - speak to a loved one, or a relative, about what your thoughts are, and also involve your doctor - they can absolutely help with this, and may be able to provide you with useful tools. Advance directives should be an ongoing discussion, not a one-time thing - revisit your choices once in a while, and always keep someone in the loop.

I realize this isn't my most uplifting post, but as science moves forward, we face new choices that are important to talk about. So chatter away!

2 Responses to “It's time to have "the talk"”

Fawn said...

Once upon a time, I sold life insurance. I've always been fairly pragmatic, so I admit I was surprised when I encountered prospective clients who just hated the whole idea of even thinking about death.

Having said that, we've been meaning to update our will since we had kids... :P

Dr. Julie said...

Yes, I think most people realize these things are important, but with the busy lifestyles we all lead, it never makes it to the top of the to-do list...

Thanks for the comment! :)

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