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-- April 13, 2020 --
Pandemic underscores crucial need
to update your Advance Directives
By Ron Fischler, MD
          While most older Americans agree that it’s important for their family and doctors to be aware of their end-of-life care goals, surprisingly few have initiated that conversation. Even fewer have put down in writing what they want and what they don’t want if time is short.
          COVID-19 now has more cases in the US than anywhere else and continues to rise at an alarming pace and threatens to overwhelm hospitals and ICUs nationwide. Everyone is cautioned to stay at home, maintain distance from others outside the household, wash hands, avoid touching the face in order to “flatten the curve” of new cases per recommendations by leading epidemiologists. 
          It is known that for older people, the chance of dying from COVID can be high, depending on age and what other diseases the person may have.
          While the majority of infections are mild, older persons are more likely (20%) to be hospitalized if they become ill, and 25%-50% of those may develop what’s called interstitial pneumonia, complicated by ARDS (adult respiratory distress syndrome) and multiorgan failure after about 5-10 days of illness. Rapid deterioration is likely. Although data are still limited, some studies suggest only 25%-50% of high-risk older people will make it out of an ICU alive; spending weeks on a ventilator is not unusual and very few patients return to their state of health before COVID.  With a shortage of ICU beds and ventilators predicted, criteria are being developed to ration their use based on who may benefit the most.
          If you are over 65 and, especially if you have chronic lung disease, heart disease, cancer, chronic liver or kidney disease, diabetes or autoimmune disease, it is time for you to think about how you want to be treated if you became gravely ill with COVID. Would you want to be admitted, alone (no visitors), to an ICU where you would likely have a breathing tube inserted in your throat, and you would be kept paralyzed and heavily sedated.
          Alternatively, you could make prior written arrangements to be given oxygen, medication for pain and anxiety, and “comfort care” if there is no hope for your recovery. This course of action could be followed at home or hospice where you could be close to loved ones until your inevitable passing.
          April 16 is National Healthcare Decisions Day, as organized by the Conversation Project, a nonprofit initiative with a goal that is both simple and transformative, i.e. to have every person’s wishes for end-of-life care expressed in writing and respected by both families and physicians.
           Everyone dies sooner or later, and having a comfortable death is possible with planning. If you unsure about how how to start the conversation with family or your doctors, visit this site TheConversationProject.org/
          If you need forms to complete your Advance Directives (Do Not Resuscitate order, and other details like ventilation, feeding tubes, antibiotics etc.) plus forms to appoint a health care proxy (power of attorney) who is authorized to speak on your behalf in the event that you are not able to do so, you will find online assistance here ThoughtfulLifeConversations.org/
          For everyone at this time, finding and expressing gratitude, asking for and receiving forgiveness,  being kind to one another and being clear about your wishes are all key to a life well lived and (if this is your time) to a peaceful and comfortable death.
 
Deaths surge in senior care facilities 
          Despite encouraging signs from coronavirus hot-spots around the globe, more than 3,600 recent deaths in US nursing homes and long-term care facilities, have residents, staffs and medical workers unnerved. 
          Because the federal government has not been releasing a count of its own, the Associated Press has kept its own running tally based on media reports and state health departments. The latest count of at least 3,621 deaths is up from about 450 deaths just 10 days ago.
          But the true toll among the 1 million mostly frail and elderly people who live in such facilities is likely much higher, experts say, because most state counts don’t include those who died without ever being tested for COVID-19.
          Outbreaks in the past few weeks have included one at a nursing home in suburban Richmond, Virginia, that has killed 42 and infected more than 100, another at nursing home in central Indiana that has killed 24 and infected 16, and one at a veteran’s home in Holyoke, Mass., that has killed 38, infected 88 and prompted a federal investigation. This comes weeks after an outbreak at a nursing home in the Seattle suburb of Kirkland that has so far claimed 43 lives. And those are just the outbreaks we know about.
          Most states provide only total numbers of nursing home deaths and don’t give details of specific outbreaks. Notable among them is the nation's leader, New York, which accounts for 1,880 nursing home deaths out of about 96,000 total residents but has so far declined to detail specific outbreaks, citing privacy concerns.
          Experts say nursing home deaths may keep climbing because of chronic staffing shortages that have been made worse by the coronavirus crisis, a shortage of protective supplies and a continued lack of available testing. Deaths have escalated in spite of steps taken by the federal government in mid-March to bar visitors, end all group activities, and require every worker to be screened for fever or respiratory symptoms at every shift.
          But infections continue to find their way into nursing homes because screenings didn't catch people who were infected but asymptomatic. 
          Last week, the federal Centers for Medicare and Medicaid Services issued recommendations urging nursing homes to use separate staffing teams for residents, and to designate separate facilities within nursing homes to keep COVID-19 positive residents away from those who have tested negative.
ELSEWHERE

AUSTRALIA -- My Life, My Choice Australia provides welcome news that the cross-party Health Committee of the Queensland Parliament has recommended the passage of a Voluntary Assisted Dying (VAD) law, similar to those now in effect in the Australian states of Victoria and Western Australia.
Read full story here: Down under

 
Action Network Administrator
  • Great news! We now have a powerful software tool called Action Network (https://actionnetwork.org). The system will provide a fast, efficient means to help us get MAID legislation passed in Arizona.
  • The system produces custom messages that our constituent/volunteers around the state can then email directly to their state senator and representatives. 
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    2. Enjoys organizing and managing an important organizational process.
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Special Events Coordinator
  • Key member of Education Committee
  • Help plan 2-3 recurring AZELO events annually
  • Secure event venues and negotiate rental fees
  • Identify state/city/community events appropriate for AZELO participation
  • Work from home 2-4 hours per week, plus longer during events
  • Manage logistics of meeting room set-up, materials, A/V and refreshments
  • Supervise AZELO volunteers at events
  • For more information, contact Education Lead Dwight Moore at: Dr.3dmoore@att.net 
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ABOUT US: We are an all-volunteer, nonpartisan, nonsectarian grassroots coalition
dedicated to passage of a state law allowing terminally ill residents to obtain
prescription medications that eliminate undue suffering at the end of life and assure a
dignified, peaceful passing. Our purpose, goals and proposed legislation are modeled after our highly respected national partners: Death with Dignity and Compassion & Choices.
The end-of–life practice we endorse is called medical aid in dying (MAID).
Arizona End-of-Life Options

Our mailing address is:
c/o 15786 W Merrell St Goodyear, AZ 85395

Please visit our website at ChoicesArizona.org