Communicating End of Life Decisions - the Importance of Advance Directives

COMMUNICATING END OF LIFE DECISIONS:

THE IMPORTANCE OF ADVANCE DIRECTIVES

A woman lies silent on a hospital bed high above the sterile tile floor. She is hooked up to three large, elaborate and expensive machines. Feeding tubes act like veins from her nose to the bags of nutrients she needs to hang on to life. With the finest and most advanced technology at their disposal, how much should the doctors and hospital staff do to keep her alive? Should they perform cardiopulmonary resuscitation if her heart stops? Should they use expensive antibiotics to keep infections at bay? Who decides?

Good advance planning for health care decisions is, in reality, a continuing conversation - about values, priorities, the meaning of one's life, and quality of life. We all have a responsibility to set out our wishes for unforeseen circumstances in health care with the possibility that we may be unable to communicate those wishes should the need arise. The need for advance directives may arise as a result of a traumatic life-threatening accident or illness, leaving those caring for you in a dilemma as to what medical treatment you would wish. If there is no advance directive, your loved ones with your physicians will have to decide what is best. They may find the uncertainty and responsibility overwhelming and distressing. In any event, setting out your wishes will increase your chances of receiving the treatment you want. You should also be aware that in the terminal phase of an illness and in the absence of any advance directive or durable power of attorney, a medical practitioner may be put in the position of carrying out treatment without knowing your wishes.

The recent case of Terri Schiavo has focused the spotlight on the issue of advance directives. Simply stated, advance directives are written instructions that state what medical procedures you want done in case you have a serious illness or accident and are unable to speak for yourself. Advance directives generally fall into three categories: living will, health care proxy and power of attorney.

Any competent adult may execute a written living will that directs the providing, withholding, or withdrawal of life-sustaining treatment and artificially provided nutrition and hydration. The living will applies when the attending physician determines you are no longer able to understand, appreciate, and direct your medical treatment; and when your attending physician and another physician qualified and experienced in making such diagnosis have personally examined you and have diagnosed that you have a terminal illness or injury or are in a state of permanent unconsciousness. As long as you are able to make your own health care decisions, the living will cannot be used.

In lieu of a written living will, you may elect to name another competent adult to make the decisions regarding the providing, withholding, or withdrawal of life-sustaining treatment and artificially provided nutrition and hydration on your behalf. This designation is often referred to as a health care proxy. (You have the option of giving the health care proxy full authority to make such decisions for you or you can direct your health care proxy the type of decisions to be made). The primary rule in choosing a health care proxy is to select an individual that you trust to make significant health care decisions. This trust usually stems from a relationship