Physicians Directives, or Living Wills, are essential

Special thanks to my PR professional wife for bringing this to my attention:

More than 1 in 4 elderly need end-of-life care decisions, showing value of living wills

Associated Press/Chicago Tribune

April 1, 2010

A significant number of the elderly — more than one in four — will eventually need someone to make end-of-life decisions about their medical care, a new study suggests.

The results illustrate the value of people making their wishes known in a living will and designating someone to make treatment decisions for them, the researchers said.

In the study, those who spelled out their preferences in living wills usually got the treatment they wanted. Only a few wanted heroic measures to prolong their lives.

The researchers said it’s the first accounting of how many of the elderly really end up needing medical decisions made for them.

Last year, end-of-life care became embroiled in the health care reform debate. A provision in the legislation would have allowed Medicare to pay doctors for counseling patients about end-of-life issues like living wills.

Critics labeled the counseling “death panels” and the proposal was eventually dropped before the researchers could get their report out. They had pushed to complete the study because of the national debate, but it took time to get it published, said the study’s leader, Dr. Maria Silveira. She teaches at the University of Michigan and does research for Veterans Affairs.

The study is in Thursday’s New England Journal of Medicine.

The researchers concluded that advance directives — living wills and health proxies chosen to make end-of-life decisions — are “important tools for providing care in keeping with patients’ wishes.”

The use of these directives has increased in the U.S. despite debate about their effectiveness. For the past two decades, hospitals and facilities that take Medicare patients are required to provide information on them.

A living will states a person’s choices for treatment if he becomes incapacitated, but critics complain they are too vague to be helpful. A health care proxy names another person — usually a relative or friend — to make medical decisions if needed. Many people have both.

Typical decisions involve the use of breathing machines or feeding tubes or giving someone CPR.

In the study, researchers looked at how often the elderly reach the point where they can’t make their own care decisions near the end of life — usually because of dementia, a stroke or a debilitating illness. They also examined how many had living wills or a proxy and the outcome.

The study included 3,746 people age 60 and older who died between 2000 and 2006. The average age was 80.

About 30 percent needed a treatment decision made before death but couldn’t do it themselves. Of those, about two-thirds had either a living will, a proxy or both.

After the person died, relatives were interviewed to find out if the person’s wishes were followed. Most reported that they had. Nearly all the patients had wanted limited or “comfort” care; only 2 percent wanted aggressive care.

Advance directives are available for individual states online,, and an attorney isn’t needed, a popular misconception, Silveira said.

“We don’t expect perfection out of these documents,” she said. “They’re there to make a difficult situation maybe a little bit less so.”

The study’s results, while “tantalizing”, haven’t convinced Dr. Muriel Gillick of Harvard Medical School that living wills are all that useful. Ideally, older patients, along with their proxy, should discuss their medical condition, goals and treatment options with a physician — instead of just signing a form, she said.

In an editorial in the journal, Gillick said the findings nevertheless “demonstrate that talking about the goals of medical care has become acceptable to a large majority of Americans who need it most.”

An alternative, she said, is a program with a more detailed form that includes doctor’s orders for specific care — called “physician orders for life-sustaining treatment.” The program has been adopted in a few states.

One community that has embraced advanced directives is La Crosse, Wis. A citywide program grew out of the counseling experience of Bernard “Bud” Hammes at Gundersen Lutheran hospital. Hammes said he saw how distressing it was for three families who had to decide whether to continue dialysis for patients who had suffered serious strokes.

He asked them what their relative would want. “In all three cases, the family said: ‘We have no idea. We never talked about it,'” he recalled.

A program called Respecting Choices is now used by the city’s hospitals, nursing homes and other health-care providers. Today, most patients — 85 percent — have a care plan when they die, he said.,0,4828075.story

free money. no really.

Reading last Sunday’s Star-Telegram was a revelation. TXU has partnered with Solarcity to offer solar panel leases for the DFW area. For an intro price of $35 a month, TXU will install a solar panel array on your house. The energy that solar array produces is first available for your consumption, and any excess is bought back by TXU, for $.075 a kilowatt hour. Installation is free, but if you are leasing, the hardware is never owned by you. The lease term is 15 years, but is completely transferable.

I’m sooooo in on this. I hope I have enough southern exposure to qualify.

New Baylor President: Kenneth Starr | Liveblog | Christianity Today

I look forward to hearing more about this high profile new president for my university.  I know he is not a Baptist… seems like he must be a Christian of good character. I find it odd that my initial concerns about the man who hounded Bill Clinton for so long is he may be too liberal and/or secular to be a good fit for Baylor. At least he is the most nationally recognized president I know of. Let’s hope he is at least a good Mason.

via New Baylor President: Kenneth Starr | Liveblog | Christianity Today.

Networking for the small business owner – free advertising

I have loved messing with computers since I was a kid with a TRS-80 Color Computer hooked up to my TV with a tape recorder drive. Prior to becoming a lawyer, I was a web programmer and database developer. I embrace technology. This has its limits, of course. I barely understand twitter and am certainly not taking advantage of it – my wife is the iphone and digital music person, not me.

There may be a purpose for search optimization companies, and for adwords with google, and for any of the many other web marketing schemes out there. But for the business owner with a tight or non-existent marketing budget, these are moot questions.

Here is my free web marketing plan that can be implemented in an afternoon, and if you are reading this, you have the skills to implement it.

  • Have a website – it can be a free single page with your address and phone number on it, free from yahoo or google or hopefully, something a little more polished.
  • get a commercial page on facebook (cost: free). These are separate from personal profiles, but you can encourage everyone you know who uses facebook to become a fan of your page. You can link a blog, website and publicize events on this page.
  • go to and make sure your business is included as a basic listing (cost:free) be sure to include business hours, if appropriate, and as much information as possible. yahoo local has an almost identical free business directory.
  • now think like a client for a second, and do a google web search for your business. notice that the google local listings show up first. Is your business there (there may be a lag as google validates the business)? If you are not but your competitor is, click on his link, see what he has done, and incorporate it into your profile.
  • look at the next listings. While they may be titled the name of a competitor, if you click on the link or just examine it, most of these links will be for other directory services, either general or industry specific. Click on the link and see what it takes to join that network – many will offer free basic listings.
  • at this point I diverge from free advertising. You may discover a well-placed directory that requires payment. I use Other business people I know swear by angie’s list. However, if you could not see this directory very quickly in the first result page of google and/or yahoo, it is not worth being paid for.

Repeat this process for both google and yahoo, exploring every link you find in the first results page (maybe into the second) for different appropriate search terms. In no more than an hour or 2, you should find at least half a dozen free places to put the word out about your business. If you know of industry specific search pages, look at those too. Each link to your site improves your original website’s natural placement in google and yahoo searches.

I’ve used this process for my own business, The Law Office of Eric J. Smith in Arlington, Texas. I also used it to help market Atomic Subs & Wings in Arlington, Texas. A quick Arlington search for probate lawyer in Arlington or buffalo wings will show the results.