"I don't get those people — the ones who say they'd rather die than be stuck in bed hooked up to machines," George Carlin once ranted. "They want somebody to pull the plug. Not me! Keep your freaking hands off my plug."
As you can probably guess, that's not exactly the "f" word Carlin employed, but his point was clear: Use whatever means possible to keep him alive up to the last nanosecond possible. It's a legitimate choice, and hurray to him for making it known while he was still able-bodied enough to stalk up and down a stage.
Mortality remains a taboo topic for too many people — and too many people die without clearly identifying the kind of medical, emotional and spiritual care that would make their waning time on earth as peaceful as it might be otherwise.
Fortunately, that's beginning to change. Baby boomers often are accused of trying to control everything in their lives and it's becoming increasingly true when it comes to the end of their lives. Many have had to make wrenching decisions for critically ill family members, and now they want to make those decisions for themselves before it's too late.
Hospitals have a role to play. Last year, the American Hospital Association's Committee on Performance Improvement commissioned two reports on how hospitals of every size and shape can increase access to services that help caregivers, patients and families manage advanced illness, raise awareness about the issue in the community, and help to ensure there's a skilled workforce to manage multiple chronic conditions, as well as provide palliative and end-of-life care.
In releasing the first report, Committee Chair Jim Diegel, president and CEO of St. Charles Health System in Bend, Ore., explained the goals of advanced illness management, or AIM: To improve patient and family satisfaction, increase quality of care, reduce inefficiencies and increase care coordination. The AIM reports are available at www.aha.org/about/org/aim-strategies-part2.shtml.
At the end of January, the AHA updated its Put It in Writing campaign, which offers resources to educate and raise awareness about advance directives and end-of-life care. The website, www.aha.org/putitinwriting, includes a brochure that provides basic facts about advance directives and encourages patients to explore their preferences for care at the end of life. There's also a wallet ID card that can be printed, signed and carried everywhere to alert health care workers that patients have talked to their family about advance directives, and the card provides contact names and numbers.
And there's a public service announcement in the form of a print advertisement or television spot in English or Spanish. Hospitals can modify the PSAs by adding their own identity and information. And they can contact the AHA at www.aha.org/contactus for a downloadable version of the files to adapt for use in their communities.
Some people contend that even talking about end-of-life care is a slippery slope toward limiting health care decisions or imposing certain decisions on people. In fact, AIM programs arm individuals with the information they need to make their own choices freely while they're still well enough to do so and before anybody else must do it for them.
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