In "Musings On Mortality," (Health, July 4), Deborah Alecson wrote " Dying in America is not the normal ending of our lives; it's a medical crisis." She states that death phobic patients will choose all the medical interventions possible. The Center for Disease Control reports that although "70 percent of people say they prefer to die at home, 70 percent die in a hospital or nursing home."

What is going on? Can it be solved?

The fact is that in a number of counties across the United States, projects are underway that are making a major difference in how their community members approach care at the end of life. Windham County is one of these!

When patients are encouraged to reflect on and talk about their personal experience with death; when they are given time to consider and then ask any and all questions they have about their choices; when they take the time to talk with their faith leaders and their loved ones about their beliefs and wishes, the picture looks different. This is not decision-making in a moment of huge stress. This is taking time, way in advance, to learn about the available options — whatever comes. This is good advance care planning.

Taking Steps Brattleboro, a community-wide project of Brattleboro Area Hospice is using the gold standard method of Advance Care Planning developed by Respecting Choices in LaCrosse, Wisc. This renowned method of facilitation directly addresses the problems noted by Alecson (see for more information).


In this method, trained facilitators help individuals reflect on their personal concerns, their understanding of the issues, and the deaths that have happened to others close to them. The facilitator helps draw out the questions the individual may have for their doctor regarding benefits, risks, and cost of medical procedures. With this method, doctors can help a patient avoid procedures that have little chance of a truly beneficial result. This interactive process helps everyone involved.

The fact is that when patients are truly consulted and have fully thought things out and stated their wishes, they may choose to take the time to relish what is in their lives currently. They often choose to not undergo expensive procedures. Their carefully considered choices may include aggressive interventions and may not (see "Being Mortal," by Dr. Atul Gawande).

Taking Steps Brattleboro specifically focusses on helping ALL adults complete an Advance Directive. For young adults there is a simple one page form. The result of using these resources is a happier outcome than the one that Alecson outlines. Change is possible.

Joanna Rueter, MSW, LICSW, Certified Respecting Choices Instructor and Facilitator, Coordinator of Taking Steps Brattleboro, can be contacted at or 802-257-0775, ext. 101.