Eideard

Thinking about death can be frightening, no matter your age or medical condition. As we get older, the reality of our own mortality tends to come into clearer focus; this doesn’t make talking about death or life-sustaining treatments any less frightening though.

It was fear — stoked by certain politicians — that led to the inaccurate and misguided “death panel” rumors that surrounded health care reform proposals last year.

Beginning January 1, Medicare will reimburse physicians who advise patients, in voluntary discussions, about their preferences for end-of-life care treatment during their annual Medicare “wellness visit.” This is advance care planning, and it is a good thing for seniors, their families and health care professionals.

It’s not new. A law passed in 2008 allowed end-of-life planning to be part of a patient’s “welcome to Medicare” exam. Health care reform turned the welcome visit into an annual wellness visit. And now regulations clarify that these important discussions will be covered should the Medicare beneficiary wish to take advantage of this opportunity.

Advance care planning allows a person to make his or her wishes and care preferences known before being faced with a medical crisis. Advance care planning is simply smart life-planning.

RTFA. Many important details and suggestions about planning for the end of your future.

You can be smart. Or you can be stupid.

A quarter of households in Britain – more in the larger cities, and a majority in some inner cities – live without a car. Imagine how quality of life would improve for cyclists and everyone else if traffic were removed from areas where people could practically choose to live without cars. Does this sound unrealistic, utopian? Did you know many European cities are already doing it?

Vauban in Germany is one of the largest car-free neighbourhoods in Europe, home to more than 5,000 people. If you live in the district, you are required to confirm once a year that you do not own a car – or, if you do own one, you must buy a space in a multi-storey car park on the edge of the district. One space was initially provided for every two households, but car ownership has fallen over time, and many of these spaces are now empty…

Car-free areas of this kind, with anything from a couple of hundred to more than a thousand residents, exist in Amsterdam, Vienna, Cologne, Hamburg and Nuremberg, among others. There is even a small one in Edinburgh.

There is another form of car-free development, so familiar we have until recently overlooked its potential. Most pedestrianised city or neighbourhood centres in Britain are almost entirely commercial. But a few farsighted councils, such as Exeter, have brought back housing and residents, without cars or allocated parking, into city centres that would otherwise be deserted after 6pm.

Groningen, the Netherlands’ capital of cycling, has the largest car-free centre in Europe: half-pedestrianised, entirely closed to through traffic, with 16,500 residents, three-quarters of whom have no car in the household. Forty percent of all journeys within the city are made by bicycle.

It all makes great sense – and worth special consideration as nations, provinces and cities move forward with plans to reduce energy consumption, rebuild the broadest possible use of urban space.

Here in the States, we’ll have to figure how to attach a gentrification tag to it. Get the upper-middle-class to think of this as somehow bestowing an aura of upward mobility. It still is difficult to sell urban benefits to a population that finds less expensive living in suburban and/or rural areas.