By Dr. Sherellen Gerhart;
It is best to make decisions in a clear minded and healthy state.
At times of medical crisis, our judgment can be clouded by the sense of urgency that accompanies critical hospitalizations. We may be experiencing pain, suffering, and/or medication that impair our ability to employ perspective and good judgment. Knowing what your basic preferences are before you get sick will provided guidance for decisions in the critical care setting. Making decisions when we are well also allows us time to have more comprehensive communication with loved ones, so they feel prepared.
Coordination of communication takes time, effort and thoughtfulness.
Unless you are very clearly communicating your wishes to your family/loved ones, they cannot be sure how you prefer to have your care handled. When you choose a proxy or surrogate decision maker, it is imperative that you take the time to have a meaningful conversation and ongoing dialog regarding preferences to ensure your desired care choices are understood and followed.
Helpful websites with tools to assist you in initiating a conversation about these topics:
5 Wishes: http://www.agingwithdignity.org
The Conversation Project: http://theconversationproject.org
Formulating and verbally expressing our personal preferences is a process, and may necessitate more than one conversation. Preferences evolve over time and as our health changes. Rarely do families sit down and draft a complete advance directive after one conversation. It is never too early to start this conversation.
Advance directives can be changed.
Just because you draft an advance directive today, does not mean you may feel the same way in 1 year, 5 years or at age 92. These advance directives can be revised to reflect your changing preferences. The exercise of completing an initial set of preferences and communicating with loved ones will have value at any time and will inform as well and make the process easier in the future.
Since we cannot predict when our health may change, being prepared and periodically revisiting our stated preferences will facilitate better outcomes and a higher probability of receiving the care we desire. You may also discover attention to these topics facilitates other important discussions and may help you determine what your desired legacy is beyond health care decision-making.
Unexpected Sudden illnesses arise.
Many of us will develop a sudden illness, which may not be immediately life threatening, but may place us at risk for loss of physical function or complications impairing decision-making.
Regardless of why someone finds themselves in the midst of these choices, we all will face a final common pathway. In our current healthcare system, Cardiopulmonary Resuscitation (CPR), has come to be an expected offering, no matter what the underlying illness or clinical condition; but CPR, as a life-saving treatment was developed and meant to be initiated on individuals who had a chance of viable and meaningful recovery. Unfortunately, CPR is often performed on people with very advanced illness or terminal conditions which results in additional bodily injury or the need for even more invasive medical care. CPR is initiated when the breathing or the heart stops (biologic death). CPR is performed as an attempt to revive or “bring the body back to life”. In the setting of a terminal illness, reviving someone may result in a far worse functional state and ensures that the individual will go on to “die again”, potentially with additional pain and or suffering. At a minimum, it is good to be sure your loved ones and proxy know your CPR preference. If you are sure you would not want to be resuscitated, your physician can assist you in documenting a “Do Not Resuscitate” (DNR) order, sometimes referred to “Allow Natural Death”.
Many of us assume that our closest family member or friend should be our medical decision maker (proxy). This choice deserves some careful thought. Making difficult decisions on behalf of another may seem overwhelming to an unprepared proxy, and may result in non-decision making if you choose a proxy who is uncomfortable carrying out decisions due to emotion or personal beliefs. Choosing a proxy carefully and communicating clearly with your proxy is one of the best ways to ensure your preferences will be followed. It is not a good practice to assume your spouse or next of kin will be prepared to make difficult decisions about your care without thoughtful discussion.
Dr. Sherellen Gerhart is the Director of Supportive Services at Epic Care. www.epic-care.com