Help your loved ones: Spell out your wishes

where we stand Candid conversation about end-of-life issues cango a long way toward ensuring dignity in dying. weblink For moreinformation on living wills and advance directives, visitTHonline.com/weblinks

When it comes to health care and end-of-life issues, patients anddoctors sometimes fear the "C" word: candor.

Talking about dying can be such a taboo subject that manypatients end up hooked up to machines or enduring procedures intheir final days while they would rather be at home, surrounded byloved ones.

In the TH series "Saying Goodbye," we talk with doctors,spiritual advisers, hospice workers and families dealing with thedeath of a loved one. All of these stakeholders see value in havingcandid conversation about death and dying.

Earlier this year, the American Society of Clinical Oncologyspoke out about the issue, saying that too often, patients aren'ttold about options like comfort care or that their chemo has becomefutile until the bitter end. The group put out a booklet along witha strong push for planning for end-of-life care.

Death is an uncomfortable topic. But it is a discussion we allneed to have. Would you want to survive on a feeding tube if youwere in a vegetative state? Would all of your family members knowwhat your wishes are? Questions like this can be cleared up if youdocument your wishes through an advance directive.

All adults should spell out - in writing - what type of care theywould want - and not want - and who has the power to make thosedecisions on their behalf if they are unable to do so. These areknown as advance directives; one such directive is a "living will,"which could detail whether extraordinary or protracted effortsshould be undertaken to sustain life. The process is notparticularly complicated. Attorneys can assist with the paperwork,and there are several Internet resources with sample forms.

One obstacle standing in the way of candid discussions about end-of-life issues comes back to politics. You might not think therewould be political spin on the issues of death and dying, butremember the so-called "death panels" of the 2009 health caredebate?

Part of the health care reform proposal was to allow doctors tobe reimbursed for the time they spend talking to patients about end-of-life treatment. There was no requirement that any patientparticipate in such counseling, but that it be available as anoption. In the battle over health care, even this counseling piecewas vilified. Sen. Chuck Grassley made this statement in an Iowatown meeting: "You shouldn't have counseling at the end of life. Youought to have counseling 20 years before you're going to die. Youought to plan these things out. And I don't have any problem withthings like living wills. But they ought to be done within thefamily. We should not have a government program that determines ifyou're going to pull the plug on grandma."

That sort of vitriol led to the measure being taken out of thebill.

That issue was purely political. When President George W. Bushwas in office, Republicans (including Grassley) supported the 2003Medicare prescription drug bill - which included counseling for end-of-life issues and care. It seems unlikely that all the Republicanschanged their minds about this issue. It just became a politicalfootball tossed to gain some yardage in 2009.

The bottom line is that both parties know that counseling on end-of-life issues is important. And those discussions would happen alot more often if doctors got reimbursed for their time.

No one relishes talking about their own demise. But candor aboutdeath and dying can be a very healthy thing, particularly if thediscussion takes place before a crisis occurs. A clear mandate on anindividual's wishes is the best way to ensure dignity in dying.

Editorials reflect the consensus of the Telegraph HeraldEditorial Board.