@AEH: It is therefore very important as you approach an age in which an end-of-life situation might arise, i.e. into your 70s when strokes, cancer, or a heart attack might leave you helpless, that you and your spouse and/or your kids have a very clear understanding of where you stand on the matter. You really should prepare a "Living Will"; a signed and witnessed document outlining your preferences. Mine goes like this:

I opted to forego the living will for the time being. The wife is well aware of my view on these things and will pull the plug when appropriate. Yes, we have discussed it in depth.

There are just so many gray areas one might find themselves in and any document containing words is subject to disagreement and the refusal of others to participate as desired.

If the document is provided to a hospital while you are hospitalized for a serious condition, the hospital will annotate your records with a "DNR" order. This essentially means your wish is to die... so should you be drowning in your own saliva, totally unrelated to the condition you are hospitalized for, you will not be suctioned and you will die from drowning. Said another way.... while the staff is discussing whether or not your condition warrants pulling the plug, you may well drown.

You're thinking pull the plug when all hope is gone. The hospital/doc is thinking DNR. There is a difference.

This whole arena is a huge issue for people with severe disabilities.... many without disabilities would rather die than spend their lives mentally impaired or unable to care for themselves, but I promise you those with severe disabilities DO NOT think that way. In your mind, you are thinking of ventilator support, comatose with no chance of recovery, unaware of your surroundings, etc. But, can you be sure the medical folk making that call have the exact same thing in mind?

It's all just too subjective for my liking. I'll let the wife pull the plug.... and I am confident she will do just that!

My wife and three kids understand where I stand on this and I'm fairly confident they will appropriately "pull the plug". I prepared the document as ammunition for them should they meet with resistance. DNR is exactly what I have in mind, saliva or not.

Further, I've had personal experience with this issue: my mother, who didn't want to be, as she put it years ago, "preserved beyond her Best By date".

I volunteer a lot of time with organizations that support those with a developmental disability.... mental retardation, autism, cerebral palsy and similar. It is a whole different perspective when you're making that decision for a frail, elderly parent than when the decision is being made on a child.

Some of these children have a standing DNR order even though they are no where near death nor have a terminal condition. Rather, it is based on the parents' perception of their quality of life and their personal values. The one truth I've learned is there is no answer that is right for all, all the time.

My mother-in-law died of cancer. She didn't want to die in a hospital or surrounded by strangers, so we moved her in with us. She passed peacefully after a few months, connected to a self medicating morphine pump.

I guess we all know how the book ends, and it is often not pretty. Quick is better I think, but that is a personal opinion.

I've asked earlier but got no response.... for those of you with a national health care program... does your program cover long term care such as a nursing home for the frail elderly who can no longer care for themselves? Or those born with severe disabilities who will never be able to care for themselves?

That's two questions.

1) Frail Elderly: in Nova Scotia, this is based to some extent on ability to pay (by the individual -- not their family), but if one spouse is in care of a nursing or assisted living home, the other cannot be forced to sell their home or car to pay, i.e., fixed assets like those are not counted in "ability of the individual to pay".

My mother, who was not poor, paid. If your money runs out, then the Province pays for the duration. There are nonetheless lots of horror stories because there is a substantial shortage of spaces available and folks must sometimes be placed fairly far from home. My brother and I live 100 miles apart but we managed to place my mother in a home half way between us.

My mother-in-law lives in an assisted living facility (a converted motel, actually) has her own room and things in it, but it has a dining hall and a nurse on duty all the time. She pays $2400/month from a teacher's pension and Canada Pension funds plus income from the sale of her home. Seems to be completely content with the arrangement.

2) There is substantial assistance for the severely disabled, but if they are not institutionalized, their parents bear a large part of the burden. Their health care costs are covered, but typically not some of their extraordinary expenses like special treatments that are not approved by the Province or out-of-province treatment.

Not entirely unlike our system (Medicaid) it would seem, except if the state pays they are going to own the home in the end. But, the surviving spouse will be permitted to continue to live there until their death. If the home is sold, the state will recoup their money from the sale.

I was under the impression that some of the national health care plans provided full coverage from birth till death..... apparently not so.

What happens in the case your wife dies before you? I hope you and her had this discussion.

Yep, a heart attack is quick and maybe painless. A few people that have survived heart attacks don't remember when they became unconscious. Most people would love to just die in their sleep as this is thought to be somewhat peaceful. However, based on the data from the World Health Organization, most people in the industrialized world will not be so lucky. Most people go through a period of 7-10 years of declining health before they die.

I simply don't know the position on terminal care here well enough, so I'll mail Stones and ask him to cover it.

The survivor will do a living will. Don't trust the kids.:)

My brother is in on the deal as well.

Absolutely. Garlic keeps contagious people at a safe distance -- although that is not the reason usually offered as to why it wards off colds. ;)

I'm surprised no one has mentioned "Sicko." Michael Moore can certainly cherry-pick his facts (he definitely rose-tints the NHS) but he's no Satan, either. Lots of things to think about.

Well, isn’t Western medicine at heart allopathic, i.e. focusing on symptom treatment? Which as far as I understand it often means treatment at odds with what the body is trying to do to cure itself...

The root cause is often unaddressed.

:D We do the same with the economy, education, etc.

So let the games begin.

http://news.yahoo.com/s/nm/20090609/...are_congress_7

Three competing initiatives, with the biggest difference being some want a public insurance option and others want simple insurance reform with no public option. And with an estimated implementation cost of over $1 trillion.

A trillion here, a trillion there.... no biggie in today's world.:)

That was definitely an eye opener. Made me appreciate what we have here in Aus. Also made sense of all those "we have cheap drugs" spams I get. I never understood why someone would be tempted to buy medications off some anonymous shyster.

What do you mean? I think that's where the NHS gets all its drugs!

Not quite as bad as it seems.... both Walmart and Wallgreen will fill a 30 day prescription of any generic medication for $5 or less. It's only the more recently developed meds where the pharmaceutical corps still have a monopoly that things get outrageous. Monopolies tend to do that.

So if you can get by on yester - year's state of the art meds, no problem. The recently developed drugs do, however, work better and access to them does increase life span.

Yikes! You do know that the only way they can do that is by massive cost shifting, right? Walmart in particular is infamous for legally not paying taxes. That means that if there's a Walmart in your town, you're probably paying higher taxes because small businesses that used to pay taxes have left, and Walmart doesn't pay its share. Heck of a free market we've got here, isn't it?

Walmart tries to legally avoid paying taxes? Well, so do I. It's the great American pass time. It's not a loophole if your well paid lobbyist got it put into law for you.

In any case, here you go. http://www.walmart.com/catalog/produ...ct_id=10179618