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End of Life Discussion


  • What do we say to the God of death?
  • Not today.

Season 1, Episode 8 “The Pointy End”
written by George R. R. Martin

Death comes for us all, and for the ones we love. Due to our discomfort with the subject, few of us are prepared to make end-of-life decisions in any thoughtful manner. Too often, we find ourselves forced to improvise when we confront the inevitable, however it presents itself. It is never easy to make end of life decisions, but the Health Plan can help.

In an ideal world, we would always have a clear definition of what we want for ourselves. We further would understand the requirements of our spouses, partners, parents, and other family members. We would have everyone’s specific wishes in neatly notarized wills. However, the circumstances of death, plus our emotional reactions, don’t always allow for neat solutions.

When my mother fell into in a coma, the procedure should have been straightforward. She had left written DNR (Do Not Resuscitate) and NHM (No Heroic Measures) instructions. But a neurosurgeon threw my siblings and me a monkey wrench: “I think I can release the pressure on your mother’s brain. If it works, she will be conscious. There will be deficits, but she will not be a vegetable.” With those few words, when we were at our most vulnerable, we toppled back to Square One.

My sister and I spent an agonizing afternoon discussing what to do, trying to figure out what our mother would have wanted, trying to figure out what we wanted, and how our ultimate choice might or might not match our mother’s personal sense of quality of life. Though another doctor had advised us to let her damaged body make its own choices, he was no longer available, and we had no other medical experts on whom we could rely.

With no trained counselors and no grasp of medical realities, we had to make a life-or-death decision at a highly charged crisis point. Looking back on a surgery that proved fruitless and pointless, I can only say that insight from a trained professional would have prevented much pain for all parties concerned.

Should you find yourself in a similarly overwhelming situation, know that “Advance Care Planning” (end-of-life counseling) is available to you. You can have this discussion with your personal Physician, and most hospitals have specially trained staff to assist you with questions and necessary paperwork. The Health Plan now offers coverage for these services.

Despite the political histrionics surrounding implementation of the ACA’s end-of-life resources, subsequent data suggests that more and more people are taking advantage of this aspect of the program. In 2016, the first year in which such services became available, nearly 575,000 people used the new program, doubling the projection for its usage despite the fact that many physicians were (and remain) unaware of its existence.

If you find yourself in need of help with an end-of-life decision, you can ask your physician for a referral that enables you to arrive at the most effective scenario for both yourself or your loved ones. Difficult though this final transition is, you will be able to survey all your options and simplify the medical technicalities.

“What do we say to the God of death?” “Not today.” But when death does come, as much as anyone can be, you can be ready.