ON OUR OWN TERMS: A DEATH OF ONE'S OWN 2000.

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More and more Americans are looking for opportunities to exert some measure of control over where and how they die. In this program, Bill Moyers unravels the complexities underlying the many choices at the end of life, including the bitter debate over physician-assisted suicide. Three patients, their families, and their doctors discuss some of the hardest decisions, including how to pay for care, what constitutes humane treatment, and how to balance dying and dignity. In the end, do these patients die the way they wanted? Yes...and no.

We fear dying in pain, we fear that too much will be done to keep us alive, or we fear that not enough will be done. What are the options? Who makes the choices? When is the right moment for final decisions? "A Death of One's Own" addresses the debate over physician- assisted suicide, where the critical issue is less the right to die, than the way to live when choices are circumscribed by practical realities

A Death of One’s Own

Program 3

Dying well, to many, means control over choices to be made as we die. We fear dying in pain; we fear that too much will be done to keep usalive, or we fear that not enough will be done. “A Death of One’s Own”looks at the issues surrounding efforts to control how we die and the

implications for families, institutions, and communities.

Additional Notes and Information from Video:

Understanding Advance Directives

No matter how hard we try to envision the future, advance directives and living wills don't cover every situation. In theory, these documents are meant to ensure clear-headed decision-making about emotional decisions regarding end-of-life care. Kathy Glasmire, Associate Director of Sacramento Healthcare Decisions, warns that, "the advance directive documents tend to focus on a procedure or a treatment, rather than on what the goal is at the other side of the treatment." In other words, the forms themselves cannot replace the heartrending decisions that families have to make but they can provide an opportunity to begin an end-of-life care conversation for you and your family.

Glasmire also suggests that having this discussion in advance encourages the notion that a family is comfortable with the decision they've made, that they can be caring and well-informed advocates for their loved ones.

Terms

Advance Directive
Written instructions specifying the type of future medical treatment to be used in the event you become unable to speak for yourself. Advance Directives are state-specific and fall into two categories: Living Will and Durable Power of Attorney.

Caregiver
A person who provides care for the elderly and/or ill so that they may remain in the home. It is estimated that 80 percent of at-home care received by older Americans is provided by family members - spouses, children, grandchildren and other relatives.

Durable Power of Attorney for Health Care
A document that grants another the power to make decisions concerning medical care in the event you cannot make those decisions yourself. Also called a "health care proxy", the appointed person is authorized to speak for you any time you are unable to make your own medical decisions.

Hospice Care
An individualized program of support for people within the final stages of a terminal illness and their families. Hospice care may take place in the patient’s home or in a hospice facility. The emotional, psychological, and spiritual care also includes the family that continues to receive ongoing support even after the patient dies. In 1999 almost one-half million Americans took advantage of this special service.

Living Will
Written instructions specifying the type of medical care to be used at the end-of-life once the patient is incapacitated.

Palliative Care
Care which focuses on providing comfort and relief from suffering with the goal of ensuring the highest quality of life for the terminally ill. Also called "comfort care", palliative care helps the dying person remain at home and a functioning part of the family. Palliative care may also include support for the patient’s mental health and spiritual needs.

Think about these issues:

Discussion Questions

If you were to become terminally ill, would you want to choose your time of death? How much input would you want a doctor or other healthcare provider tohave if you could no longer speak for yourself? Have you shared your thoughts with your family?

What issues are raised for you when you consider terminal sedation, physician assisted suicide, and dying assisted only by palliative care?

Why might disabled, poor and mentally ill people oppose physician assisted suicide? Is legalizing physician assisted suicide good public policy?

A doctor’s oath is to “do no harm”. How can a doctor best abide by this oath in the final stages of terminal illness?

What choices about death do terminally ill people, their loved ones, and doctors have in your community? Do you feel they are sufficient or insufficient? Why?