Thank you for this ViewPoint. You said it very well. Too often people wait until advanced years to formulate an advance directive, make their wishes known, or fail to see a need until a life ending diagnoses is made. The best time to make an advance directive is when health is stable and judgment is not impaired by emotional and fearful thoughts of the dying process. The Missouri End of Life Coalition in collaboration with the Missouri Attorney General's office released last summer a "Life Choices" booklet that guides individuals in developing their wishes for end of life situations. The 40 page booklet is free, can be ordered or downloaded. 8000 have been printed and distributed to date. www.ago.mo.gov/publications/lifechoices/lifechoices.htm; e-mail email@example.com; or call Consumer Protection Hotline: 1-800-392-8222, to access a copy. This is Missouri tax dollars at work!
The Cruzan case showcased the issue of the rights of the dying for the State of Missouri. John Danforth, U. S. Senator at the time, put forth what is known as The Patient Self-Determination Act, passed the year after the Cruzan decision, which requires each person to be informed of their right to make an advance directive when they are admitted to a hospital or nursing home in every state in the entire country-it is the law for any facility receiving Medicare or Medicaid monies. The Missouri End of Life Coalition works to advocate and educate for the rights of the dying in Missouri. Last year the Coalition released a unique Manual called "Guidelines for End-of-Life Care in Long-Term Care Facilities". It is recognized that by 2020, 40% of the deaths in the United Stated will take place in nursing homes, currently in Missouri, 28 - 32% of deaths occur in long-term care facilities. Increasingly, nursing homes will become the last place of care. The Missouri End of Life Coalition wished to provide education to those involved in long term care to increase the quality of services for the dying and their families. The Manual won a national award that was presented to the State by the National Association of Survey Agencies in September, 2004. The Manual is now being considered for adoption in other states. Cruzan was a wake-up call that Missouri took very seriously and has resulted in the State of Missouri being in the forefront of end of life issues. I have been as far away as a conference in California when the topic of end of life issues centered on the Cruzan case. Let us never forget the willingness of the Cruzan family and Bill Colby to make a difference in end of life decision making for those of us in Missouri. The Long Goodbye, by Bill Colby, should be required reading for all individuals assisting families in end of life decision making.
There are significant gaps between the way people are dying in this country and the way they wish to die. Your editorial was a great reminder of the control individuals can have in end of life situations. Thank you.
Mary E. Mitchell, Chairperson
Coalition of End of Life Care in Southeast Missouri
Member, Missouri End of Life Coalition