Dying isn’t what most people want to talk about when they visit the doctor. But it could soon become a standard part of a check-up. Some private insurance companies already reimburse doctors for end-of-life conversations, and Medicare is considering joining the club.
When people over 65 end up in the hospital, about half of them eventually need someone else in the family to make decisions for them—End of life decisions.
Still, only a small percentage of people—under 30 percent in the U.S.—have written advanced directives.
Tech entrepreneurs are trying to change that by creating apps and online databases to store and edit end-of-life wishes.
Scott Brown and Jeff Zucker started one such company, called My Directives. It’s a web-based system they hope will become a sort of Facebook of advance directives.
Right now, Brown says, end-of-life wishes are still stuck in the era of file folders.
“That document, once it’s created,” Brown says, “it’s placed in a shoe box or file cabinet or safety deposit box, and it’s not available when it’s needed. People can’t plan their emergencies Monday through Friday 9-to-5.”
Cutting Out The Legal Jargon
Online sites and apps for living wills make it possible to upload and edit the medical procedures you do and don’t want in your final days. They’re also a way to personalize end-of-life wishes.
The "My Directives" site, for example, allows you to upload video messages to loved ones.
Christine White, 62, is a social worker in Salem Oregon who uses My Directives.
In a note to her husband, she wrote the following:
“If I precede my husband, I want him to know that his incessant whistling was the joy of my life. In fact, every day with him was a gift I cherished.”
“I felt so much better he would know how much he meant to me,” she says.
Costs, Savings, And Criticism
In addition to emotional relief, proponents of advance directives say they can save money.
Still, there are plenty of advance directives critics.
Dr. Henry Perkins has been researching advance directives for 35 years, and he still doesn’t find them very useful.
“They promise more control over future care than is possible, they are hard to implement, and some doctors don’t follow them,” says Perkins.
He recommends patients choose one or two people whom they trust a great deal to be their surrogate decision makers in a time of crisis. “The best we can do is ask people to be there for us,” he says.
Control Through Technology
Dr. Molly Coye, chief innovation officer at the University of California, Los Angeles, envisions a world where talking about the end of life is normal; Perhaps part of signing up for health insurance, getting a driver’s license or applying for a mortgage.
“People are ready to hear this I think,” she says. “It’s just so far there are not a lot of people who have been approached about it.” Coye says new tools and technologies make end of life documents more accessible and easier for doctors to follow in emergencies.
As for patients, moving the advance directive from the shoebox to a smartphone means making updates is less dusty, and a lot faster.
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