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GUEST EDITORIAL: Make advanced care planning a family priority

The St. Augustine Record - 2/12/2017

Todd Batenhorst,MD

St. Augustine

I am compelled to respond to the Jan. 5 Guest Editorial ("Deadly 'end-of-life' myths).

The author, Betsy McCaughey, asserts that chronic disease is declining and makes sweeping generalizations about treatments such as ventilation and artificial nutrition. This is done to strengthen her thesis that our government and those who receive payment from it want patients to forgo treatments to save money for the system.

This "slippery slope" argument is used to frighten older adults and encourage many to avoid one of the most important things they should do: advance care planning.

Patients and families should discuss their wishes with their health providers before making important decisions - preferably when still healthy.

In Florida, we have the right to decide what medical treatment we do or do not want as we face serious illness. Unfortunately, only one-quarter of the population has an advance care plan. The reality is nearly 85 percent of us will die while interacting with medical care - in a nursing home, hospital, ambulance or other care facility. In a crisis situation, patients may be unable to express their wishes. Without an advance directive in place, caregivers will be left to make their best judgment about what you, the patient, would want.

McCaughey's assertion that chronic disease is on the decline is not substantiated by the facts. The number of Americans with chronic, incurable diseases is actually growing, according to credible sources such as the RAND Corporation. Chronic illness will affect almost half of us by 2025.

The Centers for Disease Control and Prevention and Centers for Medicare & Medicaid Services, among many others, validate this finding. Chronic illness accounts for almost 99 percent of Medicare and 83 percent of Medicaid spending and is responsible for seven out of every 10 deaths in the U.S. today.

While the most expensive 10 percent of patients do account for 65 percent of all medical spending in the U.S., that is not the real issue. What concerns medical providers most is when patients and families make decisions unprepared. The results can be very poor and often have unintended outcomes.

Florida law requires that patients lack the ability to speak for themselves and have a terminal diagnosis, end-stage condition or be in a persistent vegetative state before an advance directive becomes effective. An important part of advance care planning is identifying someone to speak on our behalf when the conditions above are present.

Doesn't it make sense to choose that person rather than have the hospital or doctor choose, as Florida law allows? And shouldn't that person know, in advance and in writing, the care you want so your wishes are honored?