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COMMENTARY: Early conversation eases end-of-life challenges


In 1991, when my older brother sent me a copy of his living will, I was a little bit surprised since he was only 43 and in good health. Perhaps anticipating how I might react, he included a note that said: “Don't go goofy, this is just in case. Put it in a safe place.” So I filed it away with all of my other important papers, such as my birth certificate and diplomas, not really giving it another thought.

Twenty-one years later, my brother suffered a fatal heart attack after disembarking from a plane in Denver. He had flown in from Chicago to attend our niece's graduation from the University of Colorado in Boulder, but instead ended up in the cardiac intensive care unit at the university's hospital in Aurora. When I arrived at the facility, I was asked if he had an advanced directive, a question that revealed the severity of his condition. I called my husband who was at home, directing him to the file where I kept Chuck's living will.

I was in shock, operating on autopilot, but I knew exactly what I was supposed to do because I had had “the conversation” with my brother.

Journalist Ellen Goodman started The Conversation Project in 2010, after she and a group of colleagues gathered to share stories of “good deaths” and “bad deaths” involving their loved ones. The objective was to encourage people to talk about death and make their last wishes known, while they are still of sound mind and body. Although more than 90% of Americans think it's important to talk about end-of-life care, less than 30% actually have had that conversation, according to a survey conducted by the organization.

The National Business Group on Health provides resources to employers to help them encourage their employees to address end-of-life issues such as caregiving, serious illness, bereavement and advance care planning to help ease the transition, while maintaining employee productivity and well-being.

Advance care planning also is essential to resolving the health care crisis since it reduces costs for end-of-life care, which accounts for about 25% of the Medicare budget.

The “death panel” debate may have killed a provision in the U.S. Patient Protection and Affordable Care Act that would have provided payment to physicians for end-of-life consultations, but as health care costs continue to climb, end-of-life policymaking soon will become as inevitable as death itself.

As we approach National Healthcare Decisions Day on April 16, now is a good time for employers to urge employees to have “the conversation” with their families. April 16, the day after the deadline for filing income tax returns, was chosen in acknowledgment that only two things in life are certain: death and taxes.