How advanced directives can improve end-of-life care, costs

Share story

Home death care
Members of the Minnesota Threshold Network sing to Anne Conley during Conley's final days of life at her home in St. Paul, Minn. April 17, 2012. Conley was diagnosed with breast cancer June, 2011 and died at her home less than a year later. Conley had chosen to hold a three-day vigil at her home rather than a traditional funeral, and received guidance from Minnesota Threshold Network members about home death care.
MPR Photo/Jeffrey Thompson

People in La Crosse, Wis., are preparing for death differently from any other place in the country.

Nearly everyone in La Crosse has an advance directive, a document that explains your treatment preferences for medical care if you're faced with a serious accident or illness, according to a recent NPR piece:

Some 96 percent of people who die in La Crosse have an advance directive or similar documentation. Nationally, only about 30 percent of adults have a document like that...

It's become such a comfortable conversation basically because of one guy in town. Bud Hammes works as a medical ethicist at a local hospital called Gundersen Health System. For years, he was called when someone's dad had a stroke, was in a coma, on machines. Bud would sit down with the family and try to help them figure out what to do next. And every time, he says, the discussion was excruciating.

"The moral distress that these families were suffering was palpable," he says. "You could feel it in the room."

On The Daily Circuit, we discuss how medical tools like advance directives change the way we receive and pay for medical treatment at the end of life.


The Minnesota Health Care Directive
A health care directive is a planning tool used to identify who you want to make decisions for you if you aren't able, and put your preferences and wishes regarding end-of-life health care in writing. (University of Minnesota)

Questions and Answers About Health Care Directives
A health care directive is important if your attending physician determines you can't communicate your health care choices (because of physical or mental incapacity). It is also important if you wish to have someone else make your health care decisions. In some circumstances, your directive may state that you want someone other than an attending physician to decide when you cannot make your own decisions. (Minnesota Department of Health)

How Can We Reduce End-of-Life Health-Care Costs?
Balancing cost, care and quality of life near death remains a puzzle for policy makers, practitioners, and of course, patients and their families. With this difficult calculus in mind, we asked The Experts. (Wall Street Journal)

Better, if Not Cheaper, Care
The more important issue is that just because we spend a lot on end-of-life care does not mean we can save a lot. We do know that costs for dying patients vary widely among hospitals, which suggests that we can do better. And yet no one can reliably say what specific changes would significantly lower costs. There is no body of well-conducted research studies that has proved how to save 5, 10, much less 20 percent. (New York Times)