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Barbara Bush’s Death Teaches Lessons about Comfort Care

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The issues of comfort care and end of life medical decisions are front and center with the death of Barbara Bush. Earlier this week America lost one of its best-known and most-admired citizens, former First Lady Barbara Bush. She passed away Tuesday April 17th at age 92 in her Houston home, surrounded by family, including her husband George H.W. Bush, our 41st President. Barbara Bush was one of only two women in history (the other being Abigail Adams) who was both the wife of one President and the mother of another, and she remained an admired and respected public figure for much of the past four decades.

“Bush possessed a no-nonsense style that pulled no punches and told it like it was — graciously,” read the Houston Chronicle story of her passing. “The Texas matriarch was a strong, steadfast partner in her husband’s political life, privately offering her own opinions while standing dutifully by his side as they moved around the country and world in pursuit of his ambitions.” George and Barbara Bush, the article goes on, “exemplified a certain Texas grace, showing politeness, kindness and respect with a steady sense of humor. They ushered in an era of political prominence for the state and their family that would span decades.”

What really got our attention here at AgingOptions, though, was this insightful analysis on the Fox News website by regular Fox contributor Dr. Marc Siegel. “Barbara Bush was a pioneer not only in life, but in how she chose to spend her final days,” Siegel writes. “[Her] decision to not seek additional medical treatment and instead focus on ‘comfort care’ shortly before her death Tuesday put a spotlight on a hard and painful question millions of Americans are confronted with every year: When is it the right time to back off from the most aggressive options of modern medical technology and treatment?” As Siegel accurately puts it, there is no right answer to this question that applies to everyone: “None of us carries expiration dates. There is no medical ‘off’ switch set with an automatic timer.”

End of Life Decisions

While the decision concerning when to forgo further medical treatment and, as First Lady Barbara Bush chose to do, shift to what is called comfort care, is intensely personal and individual, in a way it affects us all. That’s because of a surprising statistic that Siegel cites in his Fox News article: “more than a quarter of Medicare payments,” he states, “go to people in their last year of life.” Siegel’s article has a link to this study from Kaiser Health News that shows how the average Medicare beneficiary in 2014 received just over $10,000 in benefits, while the average benefit paid to those in their final year of life was more than three times that high, at nearly $35,000. “As technology continues to advance and become more and more expensive,” says Siegel, “it also becomes more and more relevant to ask whether the results are worth it.”

In Barbara Bush’s case, she decided the answer was no. “Barbara Bush answered the question of when to scale back care for herself in a courageous way,” Siegel says in his Fox News column. “Faced with recurrent hospitalizations over the past year and shortness of breath from chronic obstructive pulmonary disease (chronic bronchitis, emphysema), and heart failure, she opted Sunday to choose comfort care instead.”

What is Comfort Care?

The term “comfort care” may be misunderstood. Opting for comfort care does not mean, as Siegel asserts, that older patients don’t deserve all the benefits of strong medical intervention when they are medically warranted. By choosing comfort care over invasive and uncomfortable medical efforts that were bound to prove fruitless, Bush made the choice about how she wanted her life to end. “Comfort care means Mrs. Bush likely tried to enjoy her remaining days at home as best as possible – with food, oxygen and basic medicines – rather than being rushed to a hospital emergency room, trying to postpone the inevitable,” says Siegel.  Indeed, in death as in life, “Barbara Bush showed us the way to a different approach – an approach that is more spiritual and quality-based, and less about all-treatment-is-automatically-good no matter what. She lived her life with class and strength. She died the same way. We were all blessed to have her as our First Lady.”

When is enough?

When it comes to medical treatment, this question of when enough is enough can be, as we said, both intensely personal and emotionally wrenching. But it doesn’t have to be that way, especially if each of us takes the time to make our end-of-life wishes known to our family and our medical providers well in advance of a health crisis. This discussion, as difficult as it may seem, can be a very helpful part of a family conference, guided by one of our staff attorneys, in which families get a wide range of issues out on the table, so to speak. Time spent in a family conference today can save your family much pain, division and uncertainty years from now.


In a similar way, we encourage you to take the time today to concentrate your efforts on creating a solid and comprehensive retirement plan. A plan that encompasses all the key aspects of your retirement. By using this planning approach, which we call LifePlanning, you will ensure that your finances will be secure, your legal protection will be in place, your medical coverage will be sufficient, your housing desires will be honored and your family will be your allies and not your adversaries in helping all your retirement plans come to fruition. Please accept our invitation to join Rajiv Nagaich soon at a free LifePlanning Seminar at which these issues will be discussed and your questions will be answered. A visit to this page on our website will show you upcoming seminar dates, times and locations, and allow you to register online, or you can contact us by phone if you prefer.

“We are all mortal,” Dr. Siegel writes, “How hard do you want to fight, how much pain and discomfort do you want to endure, simply to go on for a few more days, weeks or months?” These are profound questions. But we have found time and time again that these and other challenges of your retirement years can be met head-on thanks to the power of LifePlanning. Meanwhile, for as many years as the Lord gives you, our advice remains the same:  Age on!

(originally reported at

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