Article on The Time is Now for the Five Wishes Document in Texas
Karen Telschow Johnson published an Article entitled, The Time is Now for the Five Wishes Document in Texas, 10 Est. Plan. & Comm. Prop. L.J. 101 (2017). Provided below is an abstract of the Article:
My journey on the path of addressing end of life issues began a few years ago with a friend who became a client after being diagnosed with end stage lung cancer in her early forties. Her greatest battle at the end of life was with a physician who would not speak with her about palliative care, hospice, or the progression of her disease. Because her physician would only speak about the latest treatment, when attempting to address the legal issues regarding end of life, and the documents that could be helpful, she could not hear me. It was a process physically painful for her and mentally painful for me. After she died, I knew there had to be a better way to communicate with people about these issues and I needed to find the right words to do it.
Attorneys are on the front lines of having the difficult but necessary conversations about the end of life and assisting clients by guiding them through the process of preparing legal documentation to reflect their wishes and speaking with them about how to communicate their needs to their physicians. What has been called the silver tsunami is occurring. The 2013 U.S. Census Bureau estimated there were 44.7 million people 65 years and above. Currently, 1 in 7 Americans is over 65 years of age; by 2060, 1 in 4 residents of the US will be over 65. That would be about 98.2 million Senior Citizens and almost 20 million of those Americans will be over 85.
Because healthcare status can change in an instant, all adults over the age of 18 need advanced care planning education. Decisions should be made in advance of any catastrophic events. Sudden injury or illness can unexpectedly sideline even the healthiest. As my practice has grown in this field, poorly planned end of life decisions have left families feeling lost.
Whether the youth or elder population, attorneys attempt to provide their clients with peace of mind through proper preparation, information, and execution of powers of attorney, including healthcare documents and wills. Having the legal language and the medical language providing insight for families will make us better advocates for those we hope to serve with intelligence and compassion.
When addressing unique needs for families navigating palliative care, hospice care, and various medical options at the end of life, this field of medicine and the legal community need a comprehensive tool that can provide better communication for better outcomes. Practitioners need to overcome the hurdle of how to have difficult conversations about various medical ailments by recognizing there are better outcomes for patients and families at the end of life. No one gets out of this life alive, but better endings are possible.
In 2009, a clinical study out of Melbourne, Australia measured whether Advanced Care Planning had any effect upon the patients or their families. The Abstract explained the following:
Interventions: Participants were randomised to receive usual care or usual care plus facilitated advance care planning. Advance care planning aimed to assist patients to reflect on their goals, values, and beliefs; to consider future medical treatment preferences; to appoint a surrogate; and to document their wishes.
Main outcome measures: The primary outcome was whether a patient’s end of life wishes were known and respected. Other outcomes included patient and family satisfaction with hospital stay and levels of stress, anxiety, and depression in relatives of patients who died.
Results: 154 of the 309 patients were randomised to advance care planning, 125 (81%) received advance care planning, and 108 (84%) expressed wishes or appointed a surrogate, or both. Of the 56 patients who died by six months, end of life wishes were much more likely to be known and followed in the intervention group (25/29, 86%) compared with the control group (8/27, 30%; P < 0.001). In the intervention group, family members of patients who died had significantly less stress (intervention 5, control 15; P = 0.001), anxiety (intervention 0, control 3; P = 0.02), and depression (intervention 0, control 5; P = 0.002) than those of the control patients. Patient and family satisfaction was higher in the intervention group.
Conclusions: Advance care planning improves end of life care and patient and family satisfaction and reduces stress, anxiety, and depression in surviving relatives.
Less stress, anxiety, and depression from advanced care planning are results to strive for in establishing policies and protocols that would continue to produce these outcomes. Is there a tool currently available that can be used to continuously achieve such positive results? Yes, and it’s known as the Five Wishes document. Accepted in forty-two states and interpreted in twenty-seven languages, the Five Wishes document answers the simple, yet complex question: how to talk about the end of life to address the needs of the patient/client and assist families during the end of life? The time is now for Texas to adopt the Five Wishes document.