BOSTON -- In the early stages of health care reform legislation, a provision was included that would allow Medicare coverage for patients who wanted to consult with doctors about end-of-life care. It became a politically charged issue, and the president abandoned it.

But today, end-of-life care is still a front burner issue for health care providers who see an explosion of elderly ill, and families dealing with the personal toll of long-term medical care.

For Marilyn Walsh, 67, diagnosed with terminal cancer, planning for her final days is personal, not political, and it's life affirming.

"When you take care of these things, you are taking care of yourself," said Walsh. "That's what so many people fear, being a burden. This is a way you cannot be a burden."

Walsh has talked at length with her adult children about how and where she wants to spend her last days. She's executed an advance directive which includes a health care proxy. If the time comes when Marilyn can't make medical decisions for herself, her daughter will make them for her.

"Basically, I'm thinking of my children and their responsibilities. The documents mitigate any kind of guilt for them in having to make these difficult choices," said Walsh.

They are difficult conversations to have. But health care experts say doing so can avoid pain and uncertainty.

"It's all about empowering individuals to be able to communicate their values and their wishes, and to live life on their terms," said Dr. Alan Abrams, medical director of United Health Care of Massachusetts.

The process is relatively simple: fill out a healthcare proxy and make sure your doctor has a copy. Living wills can also be executed. In Massachusetts a document known as "five wishes" is legally binding. It includes five simple instructions that include what loved ones need to know.

"Those decisions really turn out to be more spiritual approaches to the care near the end of one's natural life, and is a much more positive experience for everyone concerned," said Abrams.

Marilyn stopped chemotherapy treatments, preferring home care by North Shore Hospice. The amount of money spent on the last year of life for medical treatment many people don't want is huge, a third of Medicare's annual budget.

Marilyn says life is too short to worry about dying, so she's doing what she can to plan for the unknown. "Take the bull by the horns. It's time to step up and take care of business. Be a grown up."

Resources:

Caring Connections

Aging With Dignity

Health Care Proxy