The Dilemma of an Aging Society research study classifies elder people into four groups

A lot of discussion has centered on proposed legislation regarding "death panels" and end of life counseling. How can 10 pages in a bill that is 1017 pages long cause so much fear and rhetoric?

The reality is dying is different today. Longevity and medicine are changing how people age and eventually die. Available research shows that if you reach the age of 65, an average male will die at the age of 82 and a female will die at the age of 85. Sounds great ... everyone wants to live longer. However, at the same time our population is aging, the way people die is changing. An Office of Aging study, "The Dilemma of an Aging Society" classified the elderly into four groups:

• The first group will die after a short period of sharp decline, the typical course of death from cancer - 20 percent of all projected deaths.
• The second group will die following several years of increasing physical limitations, punctuated by intermittent acute life-threatening episodes, the typical course of death from chronic cardiac or respiratory failure - 20 percent of all projected deaths.
• The third - and the largest - group will only die after prolonged dwindling, usually lasting many years, the typical course of death from dementia (including Alzheimer's disease) and disabling stroke. The trajectory towards death is gradual and unrelenting, with steady decline, enfeeblement and growing dependency, often lasting a decade or longer - 40 percent of all projected deaths.
• The other 20 percent will die as a result of some sudden and acute event, like an accident.

Longevity implies 80% of the population will need help in managing their affairs as people age. Sounds simple? It's not. The fact is incapacity, like death, is an event in life where laws decide who has the authority to manage your affairs for you when you can't ... and what choices are made on your behalf. These laws create the need for advance directive forms, including living wills and power of attorney forms.

"Advance Care Planning Consultation": This section proposes that physicians consult with patients once every 5 years and document end of life choices. It also suggests states standardize advance directive forms and method of documenting end of life choices.

The dilemma: Research shows the majority of Americans do not understand advance directives. 85% of those polled have never heard of a power of attorney and don't understand the consequences of not creating one.

According to Kathy Lane of Die$mart, "It is absolutely critical for people to understand and make choices for end of life planning."

The discussions should not be about the need for education and documented choices, but rather:

• If a doctor and patient agree on what type of medical treatment is desired, how are these end of life wishes documented? How do people with limited resources create these legal documents?
• Are doctors open to malpractice suits if providing advice is considered giving legal advice? Some states prohibit anyone but lawyers from giving legal advice.
• The reference to common forms and common definitions implies changing existing advance directive forms. What happens to state statutes and existing end of life documents?
• End of life choices are not static choices. If the doctor and patient change their minds, how is the information communicated real-time with doctors, hospitals, nursing homes, paramedics and others?