News Planning for the End: Advance Directives

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The following story in a longer form appeared recently in the Hays Free Press, explaining the importance of advance directives for patients at Seton Medical Center Hays - and for everyone.


By Wes Ferguson, Hays Free Press

The patient was 50ish and gay, and 15 years earlier he'd been disowned by his parents for moving in with his partner. Now he was dying.

During treatment for pneumonia, the man's infected lungs became so inflamed they wouldn't respond to mechanical ventilators, recalled his physician, Dr. Patrick Garcia. His organs began to shut down. He had a stroke and a heart attack,
and his kidneys stopped working.

"It was a terminal situation, but the parents came in from out of state, and they hadn't seen their child in 15 years," said Garcia, vice president of medical affairs for Seton Medical Center Hays. "The amount of guilt they had was incredible."

The patient's parents told Garcia to stop at nothing to keep their son alive. Because the patient had no legal tie to his mate of 15 years, the man's father and mother were his closest living relatives. Doctors had no choice but to follow their instructions.

"Yet the partner was just devastated, because this is not what he (the patient) would have wanted," Garcia said. "Despite all heroic measures, the patient did die, but after weeks of suffering. Seeing his life partner have to experience that was horrible for everybody."

Surgeons and emergency room physicians say cases like this one are common and are among the most distressing aspects of their jobs: when they are legally bound to provide futile treatment that causes greater suffering for patients who are dying. The experience can also heap further anguish on loved ones who must decide whether to continue care when they are not sure of the patient's own wishes.

Such treatment also burdens the already overtaxed American health-care system, where a typical hospital stay costs about $6,000 a day.

"What stresses us out is how it affects family and caregivers, then the reality of the huge price tag associated with it," Garcia said. "If you look at the economy of our country, it's not sustainable. We can't continue to practice this way because our country can't afford it."

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Tackling the issue in Kyle, Seton Hays has begun a campaign to inform people of their end-of-life options and help them prepare for the decisions long before they are faced with them. Staff Chaplain George Rodriguez calls on four or five patients a day who are receiving less serious treatment at Seton Hays, bringing them a stack of forms that designate medical power of attorney, do-not-resuscitate orders and advance directives or "living wills."

"It's not a pleasant conversation, but the best time to talk about it is when everything is going well," Rodriguez said.

One morning this spring, Rodriguez dropped by a room where Kyle resident Ronald Logan had been receiving dialysis, his prosthetic legs draped across the white hospital bed. Rodriguez quickly ran through the need to designate a medical power of attorney.

"This would be a person you choose. It could be anyone you want, friend or family, and they would make medical decisions on your behalf until your mind clears up," he said. "Once your mind is clear you take your own authority back."

Then the living will: "The first option says if I have this condition, basically, keep me comfortable. Keep me out of pain and let me go as gently as possible. The second option says I want everything done, even though I know what I have."

Seton officials say the directives can be tailored to very specific emergency room situations. For instance, people can say whether they wish to be placed on feeding tubes or mechanical ventilation.

"We'd do everything like we do for anyone else, but should your heart stop, should your breathing stop, we're not going to initiate these heroic efforts when survival rates are incredibly low," Garcia said. "If it stops, we're going to let it stop."

What is an advance directive?

An Advance Directive tells your doctor what kind of care you would like to have if you become unable to make medical decisions (if you are in a coma, for example). If you are admitted to the hospital, the hospital staff will probably talk to you about advance directives. A good Advance Directive describes the kind of treatment you would want depending on how sick you are. For example, the directives would describe what kind of care you want if you are permanently unconscious.

What is a Living Will?

A Living Will is one type of Advance Directive. It is a written, legal document that describes the kind of medical treatments or life-sustaining treatments you would want if you were seriously or terminally ill. A Living Will doesn't let you select someone to make decisions for you.

What is a Durable Power of Attorney for Health Care?

A Durable Power of Attorney (DPA) for health care is another kind of advance directive. A DPA states whom you have chosen to make health care decisions for you. It becomes active any time you are unconscious or unable to make medical decisions.

What is a Do Not Resuscitate Order?

A do-not-resuscitate (DNR) order is another kind of advance directive. A DNR is a request not to have cardiopulmonary resuscitation if your heart stops or if you stop breathing. (Unless given other instructions, hospital staff will try to help all patients whose heart has stopped or who have stopped breathing.)

Options for Writing an Advance Directive

  • Use a form provided by your doctor.
  • Write your wishes down by yourself.
  • Call your health department or state department on aging to get a form, or go here to download forms.
  • Call a lawyer.
  • Use a computer software package for legal documents.

Can I Change My Advance Directive?

You may change or cancel your advance directive at any time, as long as you are considered of sound mind to do so.

Source: FamilyDoctor.org

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