When CBS news anchor Katie Couric had her colonoscopy televised to raise awareness about colon cancer screening, the importance of having open discussions about sensitive medical topics became clear. Today, patients and doctors freely discuss issues once hidden by shyness and embarrassment on both sides, and the result is better health care. However, there is one last big taboo in medicine: Discussions about death and end-of-life care.

I'm healthy, why should I care about end-of-life care?

No one likes to think about his or her own mortality, including your doctor. Studies show that despite efforts to help doctors start these discussions with patients, few do. However, saying that talking about end-of-life care is only for the very elderly or terminally ill is like saying that having a will or a life insurance plan is only for those who know they are near death.

Make sure your family knows what your wishes would be if you were to suffer a catastrophic injury or illness, and know what their wishes are as well. A good place to start is by filling out an advance health care directive (AHCD). An AHCD is a document that authorizes a person you trust to make decisions about your health care in the event you can't. This includes deciding when further treatment will only prolong pain and suffering.

Most doctors will provide a standard AHCD form that you can fill out and add to your medical record. At PAMF, you also can pick up AHCD forms in both English and Spanish in our Community Health Resource Centers or download the form online.

My mother has terminal cancer, but she doesn't want hospice care because she thinks it will be a financial burden on us. Is hospice expensive?

The belief that hospice care is costly and not covered by insurance is one of the reasons why the majority of people who die in California each year fail to take advantage of all of the end-of-life care benefits available to them. California patients spend roughly 21 days in hospice – well below the national average – despite the fact that they are eligible to be referred to hospice for the last 180 days of life.

Because hospice care may have more benefits for you and your mother without additional cost, it is worth looking into. Ask your doctor for the name of a local hospital or clinic health center where trained volunteers can help you learn about hospice benefits you may be entitled to and help you fill out an AHCD form.

Don't people who chose hospice have to give up their doctor and move into an institution?

Most patients prefer to die at home, and hospice helps them do this with support from nurses, volunteers and hospice doctors. Your primary care physician will still be a part of your care. You can choose from many different types of end-of-life care, including in-home care or palliative care in the nursing home or hospital. What end-of-life care really does is put you and your family back in control by giving you a lot more options about how your care is delivered. In addition, hospice will give you access to more support services for your family, such as death and bereavement counseling.

Vivien D'Andrea, M.D., is an internal medicine specialist at PAMF's Mountain View Center and chair of the Department of Internal Medicine.

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