June 24, 2009 -- As paramedics worked frantically to revive George Smink's 86-year-old mother, they did not know they were actually working against her will.
"She never wanted to be on life support," Smink said about his mother after the hospital inserted a breathing tube as she battled heart failure and colon cancer. "That is not something they do if a patient is DNR."
Smink, left with the decision of his mother's future, opted to follow the wishes of her Do Not Resuscitate order, or DNR, she included in her living will. "I'm thinking she's proud of me," Smink remembers while making this difficult choice. "I'm doing what she wants."
While living wills have advantages for families and medical professionals, they may also serve another purpose – helping the American economy. As the Obama administration seeks to alleviate some of the nation's economic troubles by reforming America's healthcare system, one organization suggests the best start is by preparing for death.
The National Healthcare Decision Day Initiative encourages Americans to complete advance directives, or living wills, as a way of reducing lawsuits, difficult decisions, and potentially unnecessary medical expenses.
According to a recent study by the Dana-Farber Cancer Institute, America could reduce medical costs by $75 million a year if more cancer patients discussed living wills with their families or medical professionals before it became too late. Assuming these figures hold true for other groups of Americans, the potential national savings could be far greater.
Nathan Kottkamp, a healthcare attorney and founder of the initiative, boasts about the success of this year's initiative that took place on April 16. According to new numbers, at least 3,755 people completed advance directive documents while the campaign exposed potentially millions of Americans to the organization's message.
"[Living wills] save Americans money because we are more efficient," Kottkamp emphasized. "This is not saving money because we are pulling the plug." Furthermore, Kottkamp insists that reducing uncertainty in the medical process can "save tons of money by not involving lawyers."
Medicare and End-Of-Life Expenses
Although advance directives cannot reduce medical expenses for all dying patients, life-sustaining treatments and other forms of end-of-life care can be extraordinarily expensive and an unnecessary strain on healthcare resources. Each year, Medicare allocates approximately 30 percent of its funds to the five percent of recipients who pass away during that year.
One recent study by the Pew Research Center shows that only 29 percent of Americans have living wills while 71 percent have thought about their end-of-life treatment preferences.
"People are squeamish," said Kottkamp. "They don't want to talk about that they are going to die, even though we all are." Additionally, Kottkamp's initiative works to demystify the process of creating a living will. "For the vast majority of people, it should be free or of nominal charge." Advance directive documents are available free on the Internet and in most states the content becomes legal upon distribution to involved parties or with an inexpensive notarization.
Government research, however, shows that living wills are not always as effective as one might hope. Roughly three quarters of physicians treating patients with advance directives were unaware they existed, as was the case for Smink's mother. Meanwhile, some doctors prefer to automatically resuscitate their patients to defend themselves from lawsuits.
Additionally, according to a report by the Department of Health and Human Services, the language in living wills is often too vague to provide clear instruction when needed, and patients tend to defer decisions to family members who commonly over-treat incapacitated loved ones.
The National Healthcare Decision Day initiative also advocates for awareness among medical professionals and the general public to increase the efficacy of these documents when they are in place.
National Healthcare Decision Day has been formally recognized by both the House and Senate and prompted official proclamations by six states. The initiative also works with the military to promote advance directives among servicemen and women.
As for Smink, his mother surprisingly regained consciousness after doctors removed her breathing tube. She continues to battle colon cancer but is not dependent on life support. "It's always what she would want," Smink said. "She always said, 'I had a long life, and whatever happens is fine.'"