Festival of Books: Steve Lopez, healthcare panelists on end-of-life struggles
The panel, one of the last at this year’s Los Angeles Times Festival of Books, was about the uncomfortable subject of death –- and, even so, it drew a lively and clearly appreciative crowd of several hundred to a USC conference room Sunday.
The discussion was moderated by L.A. Times columnist Steve Lopez, who in recent months has written a series of columns on death, illness and the struggles many families confront as loved ones age. Lopez’s interest in the subject grew out of his own father’s final illness and the tough choices his family faced in his father’s waning days. (Tony Lopez died in February at age 83.)
The panelists -- a gerontology professor, two physicians and the executive director of a California healthcare collaborative focused on end-of-life issues –- spoke of the urgency of the subject as the nation ages and as the cost of healthcare, especially of the advanced types of care that can prolong the lives of the gravely ill, skyrockets.
“Are we extending life or just prolonging the dying process?” Lopez asked at one point. He said he had turned for advice about his father’s care to several of the panelists, including Dr. Gene Dorio, a Santa Clarita physician and geriatric medicine specialist. Dorio, who makes house calls for seniors, said people’s choices for their final days must be part of an ongoing conversation for patients, their doctors and their families.
He and other panelists emphasized the importance of advance healthcare directives to help family members and doctors know one’s wishes in case of incapacitating illness or injury. And preparing a directive should not be just for the elderly.
Even more important, Citko said, is to choose a person to speak for you if you’re ever incapacitated and unable to speak for yourself. “Pick that person and tell them,” she said. “Tell them what you want and what it is that makes life worth living for you –- if that means being able to walk, to speak, to eat ice cream?”
Susan Enguidanos, an assistant professor of gerontology and social work at USC, agreed. “We need to empower the people around us to stand up for what we want,” she said. “Pick a person who’s strong enough to make the decisions and follow what you want them to do. Talk, talk, talk.”
Dr. Neil S. Wenger, a UCLA medicine professor who directs the UCLA health system’s ethics center, said many assume advance healthcare directives are about the specific medical treatments one wants –- or doesn’t want -- toward the end of life.
“But we as patients are not the best informed about treatment decisions,” Wenger said. “It’s really more about the advance laying out of one’s goals -- and to do that, you have to have time to have that conversation with your doctor.”
Dorio listed what he called seven possible solutions to the problems surrounding end-of-life care, including a greater focus by doctors and others on allowing seniors to die at home, encouraging more physicians to make house calls for aging patients and requiring members of Congress, judges and other top government officials to go on Medicare when they turn 65, which is not the case now.
He also urged better funding for senior centers and adult day care, requiring Medicare to cover hearing aids, glasses and dental work, and an innovative idea to alleviate older people’s fears of going to nursing homes by staffing such facilities with recent medical school graduates, in exchange for forgiveness of their student loans. Finally, he said transitional care facilities for seniors discharged from hospitals should be seen as steppingstones to allowing patients to return home.
He and the other panelists acknowledged that many people have a tough time talking about death or approaching a loved one with difficult questions, but urged them to start the conversation. “It should be a personal choice,” he said.
Citro’s organization’s website has suggestions for ways to broach the subject, she said, along with many other resources.
Overall, California is making progress in dealing with end-of-life issues, she said, and noted that her organization has been contacted in recent months by healthcare providers previously uninterested in the subject.
“We have a long way to go, but we’re at the beginning of a positive trend,” she said.
-- Rebecca Trounson
Photo: L.A. Times columnist Steve Lopez. Credit: Richard Hartog / Los Angeles Times