Ann, 

Nice to "hear" from you. I can really relate to what you've written, having
just lost my father last Monday.  He had Alzheimers and died in his own bed,
in his own home. that was somethign of an accomplishement, due largely to
the fact that we were able to have superb care givers who treated him as
their own family.  He had zero quality of life in the past 4 weeks, when he
got a bad case of bronchitis and went down hill from there, but were adamant
that he not be taken to hospital, even for xray - teh object was to keep him
as comfortable as possible, and moving him to a strange environment didn't
figure in that plan.  

anyway, there was no living will as such, but his being at home gave us a
lot more say in what happened to him than if her were in an institution.

So, I wish you well. Good luck with health promotion battles in Alberta.
Ours are just starting here.  the latest missive from the ministry is that
public health is now divided into ïnfectious and non-infextious diseases.
what ever happened to determinants???????

Good luck

David

At 02:03 AM 3/27/97 -0700, you wrote:
>
>Both had advance directives - Living Wills - that dealt with no heroic
>measures, and the administration of medication to provide comfort at a point
>when they were close to the end, even if it would hasten their death.
>
>If I understand the perception of saving money correctly, I assume that
>means that, if people opt for a palliative philosophy of comfort measures
>with the least invasive procedures throughout this period, however long that
>might be, then the expense of tests, surgery, equipment and/or other forms
>of treatment that are not adding to quality of life are avoided.  Is that
>what you meant?  To me, that seems to be a given.  It was applicable in our
>situation.
>
>We followed their directives in the decisions we made, and I am sure we put
>less 'stress' on the health care system as a result.
>
>I wonder if you can pose a more open-ended question (you'll be able to tell
>that I haven't had to do a thesis or dissertation proposal!) about what
>difference does it make to the person who gave the directive and to their
>caregivers, to have an advance directive in place?
>
>For us, it meant peace of mind when it came to decisions about treatment,
>about whether to introduce tube-feeding or IV fluids, about the type of
>medications to use and their amounts, and about the desirability to preserve
>and work hard for maximum quality of life, even when their capacities were
>narrowing.
>
>For my parents, I think it meant trust that the people around them knew what
>they wanted, at a philosophical level, and knew that we would honour their
>wishes.
>
>I hope these thoughts hold some value for you.  I'd be interested to hear
>more if you have time in the future to say more about your research.
>
>Ann