Today's letters: Readers comment on end-of-life care and the Constitution

·3 min read

End-of-life care planning

Nearly half of all older adults now die with a dementia diagnosis, up more than one-third (36%) in just the past two decades, according to a new study published in the Journal of the American Medical Association.

While these findings are disheartening, they also serve to underscore the importance of advance care planning for the care we want — and don’t want — should we get dementia. Thinking through these difficult decisions and having conversations with our loved ones and health care providers now, while we are still capable of making our health care decisions, will be a gift to our loved ones and to ourselves.

Dementia patients take comfort from their surroundings; transferring them to a hospital causes agitation, upset and, in the most extreme situations, trauma. Yet, nearly six out of 10 nursing home residents with advanced dementia (57%) go to the emergency room at least once in the last month of life.

Furthermore, emergency room physicians are trained to extend life. This reality means you could be subjecting a patient with advanced dementia to cracked ribs as a result of cardiopulmonary resuscitation (CPR), an uncomfortable urinary catheter or a breathing tube.

A small percentage of people may want these aggressive interventions. However, more than nine out of 10 Americans (92%) agree that a person should “have the legal right to put in writing in advance that they want their caregiver and medical team to stop medical treatments when they are at a specific stage of dementia,” according to a 2018 survey by NORC and the University of Chicago commissioned by my organization.

While every person does have a legal right to forgo treatments, operationalizing this desire is not clear-cut. Dementia is a progressive disease: it’s not always obvious to loved ones the point at which their loved one would want to forgo treatments.

I encourage all of us to give our loved ones the gift of clarity by filling out the free-of-charge Compassion & Choices dementia values and priorities online tool ( This tool helps you create a personalized care plan, based on your selected preferences, that your health care proxy can use to care for you should you get dementia. While there is no cure for dementia, we can take proactive steps to die naturally, potentially with less suffering, through advance care planning.

Kim Callinan, President/CEO, Compassion & Choices

An ironclad contract

The Federalist Papers No. 45 states, “The powers delegated by the proposed Constitution to the federal government are few and defined.”

The Constitution enumerates those few powers as the power to lay and collect taxes, borrow money, regulate commerce, establish a uniform rule of naturalization, create bankruptcy laws, coin money, establish post offices, grant patents and copyrights, establish federal courts, define and punish piracy, conduct foreign affairs, raise and maintain armed forces, call forth and organize militias, govern D.C., declare the punishment of treason, govern territories and propose amendments.

The Federalist Papers No. 45 continues, “Those which are to remain in the state governments are numerous and indefinite. The former will be exercised principally on external objects, as war, peace, negotiation and foreign commerce. … The powers reserved to the several states will extend to all the objects which, in the ordinary course of affairs, concern the lives, liberties and properties of the people, and the internal order, improvement and prosperity of the state.”

Profulla Singh, Belleview

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This article originally appeared on Daily Commercial: May 15 letters: Readers comment on end-of-life care, the Constitution