End of Life Care

END OF LIFE CARE

            I believe everyone should think about this and prepare for it prior to the expected need. It’s best to look at this issue for yourself and make decisions while you are still considered “mentally capable” or “competent” to make your own decisions. Remember the Terri Schiavo case.

This can be discussed at your annual/yearly physical exam or at other times when you are in for a well-check office visit.

            Many patients tell me they don’t know where to begin looking at this topic, and it can be confusing. Issues of religion and culture often help determine what we decide. I tell patients to look at it from the general thoughts of whether you would like to be kept alive at all costs and with any technology available; more so if there is a chance for recovery. This can be considered a quantity of life perspective. The other major view is quality of life; meaning if it looks like there is no hope of recovery than no heroic measures should be undertaken.

            There are many good web sites and news articles available to explain the differences and similarities of medical living wills, advance directives, and medical powers of attorney. The laws differ depending on the state in which you live. I’ve put one link to a national web site on my links page.

            Patients often tell me that their family “knows what they want”. This may be true, but if it isn’t written down, problems almost always come up when family members and medical staff need to make decisions. Your family members may not agree. If it questionable, or arguable, who will make the decisions for you, will it be the person who agrees with your perspective? Will other family members or friends argue about the decisions? Do you want your loved ones making difficult, emotional medical decisions when they are in the midst of grief over your situation?

 

HERE’S ANOTHER WAY TO LOOK AT THIS DECISION

There are three points that I consider, and want my medical power of attorney to think about,  when deciding what to do for me in any given situation if I am in the position of being deemed not competent to make my own medical decisions.

These are:

  1. Quality of life vs. quantity of life. I am definitely a quality of life person; don’t keep me alive just because you can.
  2. I’m either here in person or I’m in there somewhere but you’re not sure where. If I’m not here in person, let me go to where the rest of me is.
  3. If I’m in a “not here” state, what is the prospect of reversibility? If it looks worth a trial of aggressive, invasive medical care, then give it a shot. And this is where the decisions get tough.

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