As a hospital-based physician for over 10 years, I have been privileged to care for a large number of patients. Unfortunately, some of them have been terminally ill. I have been privy to hearing the patient’s side (often while they are physically suffering), and the family’s side (often while they are emotionally suffering). Because our society has evolved from multi-generational living, with the young taking care of the old, to a nuclear family lifestyle, it has resulted in the proliferation of nursing homes and assisted-living facilities that often become the “primary caretakers” of our elderly and chronically ill. Because of the limited contact that we have with our elderly relatives, we often have limited knowledge of their end-of-life wishes.
It is my professional responsibility to ascertain from the family, the wishes of the patient, often when that patient is already demented or unconscious, and unable to articulate those wishes. The process is often frustrating, because it is clear that none of these discussions were held prior to that point, and the family is often put in the precarious position of having to make decisions which are in the best interest of their loved one.
Physicians generally would like to discuss and have documentation of DNR (DO NOT RECUSITATE) elections, and advance directives (health care proxy and living will). These are medical concepts and legal terms that many people are often unfamiliar with. DNRs, health care proxys and living wills are legal documents, so they are generally State-specific. They do not require consultation with a lawyer, but some States do require that signatures be witnessed by a notary public. A DNR order is possibly the most important document you can have at end of life. In the simplest of terms, it documents one’s request to forgo CPR/heroic measures when a patient is actively dying. A DNR election can be made by the patient himself or by the health care proxy. One may ask “Why would I want to forgo heroic measures? I want my relative to live.” This statement must be qualified to capture HOW you want your relative to live. As a physician, I have seen patients and families devastated by the state in which the family member is left post-CPR or after an ICU stay. Sometimes being alive by mechanical means only (often the result of recusitation), hooked up to lines and tubes without a mental status can be far worse than death, given the resultant suffering. Medical advances are wonderful in certain circumstances, and can be life saving. However, if your QUALITY OF LIFE is severely compromised, with little hope of recovery, then the responsible family member must consider the consequences of prolongation of life.
In my next blog, I will discuss advance directives, and explain why no one should be without one…I have one! Until next time, never take your health for granted…be proactive to prevent illness, and I will help you translate health one blog at a time…