As Nelson Mandela receives intensive
care at home, what conversations did he have with wife and family about his
wishes for end of life in the event he became incapacitated? Did he want to be on a respirator and
breathing tube for prolonged periods of time?
What about feedings in the event he was unable to take food by
mouth? Did he want to be resuscitated if
he were to succumb to a disease process?
If he did have those conversations, was any information written
down?
If for some reason your heart
should stop or you are unable to breathe on your own, do you want CPR
(cardiopulmonary resuscitation) and a breathing tube? Or would you like to die
a natural death?
I ask that question to all patients
who are entering the hospital. Oftentimes patients have had experience with the
death of a loved one in the hospital after a protracted illness, including many
invasive tests and procedures. Others have
had the experience of family members opting to die at home without further
intervention.
The Patient Self-Determination Act
of 1990 requires hospitals, nursing homes, and other healthcare facilities to
provide information on advance directives to patients. Patients have the right to determine what is
best for their care. A Living Will
delineates healthcare decisions in the event a person is incapacitated or
unable to make decisions. In such a
case, a proxy, or stand-in decision maker, acts in the best interest of the
person according to their written wishes.
Communicating end of life wishes to
family members and physicians, as well as having it officially recorded is
extremely important. What someone decides
can be influenced by a myriad of factors – unresolved family issues, fear of
death, or financial incentives. Oftentimes
patients ask me to do everything if it will bring them back. I ask if they mean a return to current level
of life, engagement and wellness. If so, there are no guarantees. In some instances, the medical community can
give quantity but not quality. “Doing
everything” does not mean we can prevent your death. “Doing nothing” does not indicate that the
medical community is abandoning the patient and family, nor does it mean do not
treat.
Talk to your primary care doctor
about your wishes before you are ill, and include your family in the decision
making process. Speak candidly with your spouse and honor
his/her wishes. Also remember the
durable power of attorney for healthcare can always be modified if your life
situation changes, such as new marriage, divorce, etc. Finally, discuss this with your attorney to have
documents drawn up for a durable power of attorney for healthcare, including a
proxy for your health in the event you are unable to make decisions. To be clear, it’s not about what the proxy
wants; it’s about what the patient would do if he/she were present in the their
right mind making the decision. The goal
is to die with dignity. Be well.
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