I found that many common, expensive medical procedures are not black-and-white. Instead, they fall into a gray area, where benefits are highly uncertain.I've read that an inordinate amount of health care expense in the US is spent during the last 6 months of patients' lives. I have no hard data, but in the currently trendy bipartisan spirit of being Reaganesque, boy do I have anecdotes.I've no doubt commented on this before, but it's incumbent on each of us to appoint health care proxies and have frank, unpleasant discussions with them. During the last months of my parents' lives I often found myself speaking for them. It was terribly difficult, but made possible because I knew from conversation with them their wishes.The players during the relevant time period:Mom, 89, advanced Alzheimer's-Related dementia, congestive heart failure, approaching (like a runaway freight train) renal failure.Dad, 90, decreasing mobility and relentless grief for the 10 1/2 months he lived after his partner of 70 years died.Living wills are a start, but they barely scratch the surface. What I wasn't initially prepared for was the tremendous advances of modern medical science, including a great many tests, that could lead you where you clearly don't want to go.My epiphany was the day I was driving Mom to her appointment for an EEG and some other "noninvasive" test after she took a fall. We had our usual travel conversation:"Where are we going?""To have some medical tests.""Why?""The doctor wants them.""I don't want to go."Repeat for duration of journey.It finally dawned on me to ask myself, "Why are we doing this? There's no way we're going to do brain surgery." Other encounters included- heading them off at the pass when they started to hint at dialysis for Mom- suggesting a different location for the feeding tube some whippersnapper suggested for Mom- fighting them off when they suggested hospitalization to rehydrate Dad after he had lucidly decided on what I call "Catholic suicide," refusing all food and drink after he could no longer walk.Yes, I knew that my decisions would lead to earlier deaths than could have been provided by the miracles of medical treatment. More importantly, though, both my parents and I realized that they don't say "death or taxes," and they had made their wishes clear.So folks, bite the bullet and have those hard conversations with the people who will speak for you if you can't speak for yourselves. You owe it to them.Phil
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