Mapping Your End-of-Life Choices

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As important as it is to have your health care directives in place, to help your doctors and loved ones make wise medical decisions should you ever be unable to speak for yourself, you probably don’t realize how limiting and confusing those directives can be.

For example, if you want to be ventilated temporarily if say you came down with pneumonia and the procedure kept you alive until antibiotics kicked in and you could breathe well enough on your own. What you would not want is to be on a ventilator indeterminately, or to have your heart restarted if you have a terminal illness or could end up mentally impaired.
Unfortunately, nuances like these escape the attention of a vast majority of people who have completed advance directives (AHD), and may also discourage others from creating directives in the first place.
Two doctors and a nurse who were aware of the limitations of most such directives created a service in 2008 to help people through the process, no matter what their end-of-life choices may be.
The “Good Medicine Consult & Advocacy”

a San Francisco-based service, was founded by Dr. Jennifer Brokaw, 46, who was an emergency room physician for 14 years. Dr. Brokaw observed doctors who cared for patients in crisis situations; they were not meeting the needs and wishes of most patients. She realized something had to be done, and soon after Sara C. Stephens, a nurse, and Dr. Lael Conway Duncan, an internist, joined her.

The communication gap was huge. The emergency room doctor has to advocate for patients. I felt I could do that and head things off at the pass by communicating both with patients and physicians.

Dr. Jennifer Brokaw

At Good Medicine in San Francisco, Dr. Brokaw and her colleagues have thus far helped about two-dozen people explain their goals and preferences, at a cost of $1,500 for each person.

In today’s health care systems, families will be asked when patients can’t speak for themselves and many families are very unprepared to make these decisions

Dr. Jennifer Brokaw

Only about a quarter of American adults have advance care directives of any kind, and only half of them have them on hand or know where they are should they be needed. Furthermore, only 12 percent had any input from a physician when filling out the forms, which are often done alone or with a lawyer.

Your lawyer shouldn’t be writing a medical contract any more than you’d want your doctor to write a legal contract.

Dr. Jennifer Brokaw

The kinds of questions should people consider:

  • What was your state of health at the start of the illness?
  • What state are you likely to be in at the end of the illness?
  • What, if anything, can provide a soft landing?

You can also use our free Advanced Healthcare Directive eBook to help you start your AHD.

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