Republished from: https://www.asaging.org/blog/making-it-easier-talk-about-advance-care-planning
By Scott
Bane
I have
family members who believe that if they talk about end-of-life issues, they
will hasten death. They resolutely back-up their beliefs with silence and
inaction. They are not alone in this. As a general rule, most of us don’t like
to think or talk about the end of our lives. Isn’t this always the way? Even if
we know something is good for us or important, if it’s hard or will make us
uncomfortable, we put it off.
But as a
matter of public policy, collectively we as a society have decided that it’s a
good thing to consider and plan for serious illness or death. As a result, all
states have some form of advance care planning codified into law. Advance care
planning helps people specify the kind of care they would like – or not like –
in the event they are seriously ill or dying. Effective January 1, 2016,
Medicare began paying medical professionals if a patient wished to have an
advance care planning conversation.
Technically,
advance care planning need only take place between patients, their families,
and medical professionals. But since drafting legally-binding paperwork is
involved, lawyers have historically stood at the threshold to this planning
process. Ideally, a conversation between
a lawyer and his or her client will focus on the patient’s values, goals, and
wishes. The lawyer then documents these
values and goals by creating a health care proxy, living will, and/or health
care power of attorney.
Advance care
planning is always important, but it becomes even more important as one ages or
is living with chronic illness. Still, only about a third of adults have
completed advance care planning. Not
surprisingly, these numbers rise for older adults. Several studies put
completion of advance care planning by adults age 65 and older at roughly 50
percent.
To help
change this, The John A. Hartford Foundation made a grant to the American Bar
Association – Commission on Law and Aging. In 2018, the ABA Commission on Law
and Aging sponsored an expert summit at which legal and medical experts drafted
a practical, step-by-step guide for lawyers to help them guide their clients
through advance care planning. The resulting document Advance
Directives: Counseling Guide for Lawyers
was released on October 17, 2018. The President of The John A. Hartford
Foundation Terry Fulmer later discussed the guide in an article published by Next
Avenue.
Now comes
the hard part of actually getting the Guide into the hands of lawyers who will
use it. The ABA Commission on Law and Aging and its partner organizations on
this project, such as the American Academy of Hospice and Palliative Medicine,
are reaching out to legal and medical publications, as well as radio and social
media to promote the Guide. We know that it takes sustained effort over a long
time in order to actually change practice.
To that end, the ABA Commission on Law and Aging also plans to distribute
the guide to state and local bar associations, as well as to medical and legal
partnerships around the country.
Recognizing
the critical role the legal education plays in shaping practice, the ABA
Commission on Law and Aging will also put the guide into the hands of legal
educators to use in elder law clinics and in continuing legal education
courses. It’s hard to change practice, but given the reach and prestige of the
ABA Commission on Law and Aging, its partner organizations, and its allies including
members of the American Society on Aging, this project has great likelihood to
shift practice for the better regarding advance directives for older adults.
Scott Bane,
JD, MPA, is a recent graduate of CUNY School of Law. He joined the staff of The
John A. Hartford Foundation in New York City as a program officer in September
2018. Visit johnahartford.org for more information.
Other
Advanced Care Planning Resources from Advance Directives: Counseling Guide for
Lawyers:
- PREPARE for Your Care™
- The Conversation Project
- Consumer's Tool Kit for Health Care Advance Planning
- The Stanford Letter Project
- CaringInfo
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