When Bernard “Bud” Hammes began his career in 1984 as the clinical ethicist at Gundersen Lutheran Hospital in La Crosse, Wis., he had near-daily talks with families whose loved ones could no longer speak for themselves.
Particularly difficult cases involved elderly kidney-failure patients who had suffered debilitating strokes. Decisions needed to be made whether to continue with dialysis or whether to subject them to “heroic” measures, like rib-breaking CPR or intubations that are often more abusive than healing.
“They were paralyzed, unconscious and unresponsive,” Hammes recalled. “We'd ask 'What would your mother or father want to do if they knew everything you know?' They all gave the same answer, which was: 'We don't know.' ”
In 2014, CMS data found that 55% of U.S. nursing-home residents had an advance directive.
To combat what system leaders perceived as a stigma surrounding death, the Gundersen Health System's Respecting Choices advance-care planning program was born. It started with dialysis patients in 1986, and by March 1996, it was found that, of the 540 adult La Crosse residents who had died in the previous year, 96% had advance directives in their medical record.