New survey about Californians' end-of-life wishes ? Santa Cruz ...

(Dallas Morning News)

Fewer than one in four Californians has written instructions about how and where they would like to die ? risking the immense emotional, physical and financial burden of end-of-life hospital care.

Yet an overwhelming majority of Californians would rather die at home, far from the tumult of a hospital, according to a poll released Tuesday. ?There is a huge gap between the place and way that people would like to spend their final days ? and the place and way that they do,? said Mark D. Smith, president and CEO of the Oakland-based California HealthCare Foundation, which commissioned the survey.

Its findings echo the passionate voices of Bay Area News Group readers who, after a Cost of Dying article, said they want to spare their families the burden of end-of-life hospital care.

But many were uncertain how to ensure that their wishes were carried out.

The survey, ?Final Chapter: Californians? Attitudes and Experiences with Death and Dying,? notes that California?s elderly make up a growing share of the state?s population. The number of residents older than 85 has quadrupled over the past 40 years.

It found that:

Nearly 8 in 10 Californians said that if they were seriously ill, they would want to speak with their doctor about end-of-life care. But fewer than 1 in 10 report having had a conversation, including just 13 percent of those 65 or older.

Eighty-two percent said that it is important to put their wishes in writing. Less than one-quarter have actually done so. More than half say they have not talked with a loved one about the kind of care they want at the end of life.

Seventy percent said they would prefer to die at home. But only 32 percent pass away in their homes, according to the California Department of Public Health.

The family of Napa?s Graeme Plant, who died Nov. 10, is deeply grateful that he took steps to ease their decision to let him die at

home from pneumonia, rather than at a hospital.

Plant had watched his mother and sister slowly deteriorate with Alzheimer?s disease and wanted to spare himself that fate.

Letter to family

So in 2003, he penned an eloquent letter ? then had it notarized, and mailed to every family member ? stating: ?If I develop Alzheimer?s before a cure of the disease ? I do not want any unusual or heroic measures to be taken to save me. Another disorder which would shorten the ordeal would be welcome. Life without memory is disorienting, meaningless and frustrating.?

?He couldn?t have been more prescient,? said son Malcolm, of Berkeley. When Plant developed the brain disease and then a lung infection, ?We elected to take him home, knowing that he would die peacefully there. Though I miss him very much, I remain extremely grateful for the gift he gave us. ? We were certain that we were doing the right thing.?

San Jose?s Harpreet Sandhu, 59, who before his liver transplant was told he had only three days to live, signed a Do Not Resuscitate order to make sure his family knew his final wishes.

?My DNR firm states that if I am unconscious or in a coma for 30 days ? or there is no chance of a normal life, let me go,? he said.

?Death is inevitable,? he said. ?Why not face with grace and be ready for it? Speak with your loved ones, too, and let them know not to be afraid, when it does come.?

Wishes not followed

The survey, conducted in the fall, interviewed 1,669 Californians, including 393 who had lost a loved one in the past 12 months.

Only 44 percent of Californians who have lost a loved one in the past 12 months say medical providers completely followed their loved one?s end-of-life preferences.

These numbers drop to 26 percent for those whose loved ones had a language barrier and to 25 percent for patients who were uninsured.

A major barrier to effective end-of-life planning is the lack of frank discussion between patients and health care providers, said Smith, the foundation CEO.

The new poll finds broad support among Californians, regardless of political affiliation, for reimbursing doctors to talk about end-of-life options. This was part of the Obama administration?s original package to expand health coverage ? but it was dropped after opponents branded the proposal as ?death panels.?

?My sense is when you step outside the red-hot political circles of Washington and talk with doctors and patients and families,? Smith said, ?everybody is struggling with same problem, and everybody wants to make it better.?

?Patients and their families would prefer a less intensive, less technological exit,? he said.

But unless those preferences are put in writing, he said, ?the system ? almost always with the best of intentions ? imposes those things on them.?

Contact Lisa M. Krieger at 408-920-5565.

Source: http://www.santacruzsentinel.com/rss/ci_19958068?source=rss

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