One of the most stressful things a physician faces is when a patient is severely ill with little hope of recovery, but the family disagrees on how aggressive the medical care offered should be. When the patient is unable to voice his or her own choices, physicians look to family members to help in the decision making process. Some family members wish that only comfort care should be given while others want every single heroic method tried in order to save their loved one.
The doctor intent on giving the best care possible to the patient may be put in the middle of an intense family argument.
It is truly a gift given to loved ones when a person makes their end of life decisions clear long before the need for such directives ever arises. There is then no guessing, and a huge burden is removed from family members at a very stressful, emotional time.
Making wishes for care known before the crisis occurs also helps to assure that a person gets the care they want. The ethical principle covering this is called personal autonomy. It means making personal decisions based on one's own values, beliefs, desires and best interests.
Most Americans find it hard to discuss end of life issues. It is uncomfortable to talk about death and certainly not the usual dinner table conversation. However, not having such discussions may mean a person does not receive the treatment they would want.
Some of the topics families should discuss are:
• Living arrangements when someone can no longer care for themselves
• Quality of life versus quantity of life
• What kind of medical care is wanted at the end of life
• Should medical care ever be withheld, even if it would allow a person to live longer?
• What about artificial feeding? (feeding tubes or IVs)
(Remember, there are no right answers or opinions #- these represent an individual's own thoughts and feelings.)
If a person can't make their own health care wishes known (because of severe illness, Alzheimer's or a condition like a stroke), they can plan ahead and appoint someone to speak on their behalf. This person is called a health care agent, proxy or durable power of attorney for health care. A health care agent is there to make decision about medical care #- even to the point of stopping certain treatments. Obviously this must be a person both respected and trusted to convey a person's desires. The agent is an advocate for the patient, letting that person's wishes be known and adhering to the values important to that patient. There is no financial responsibility in being a health care agent.
A health care agent must be over 18 and cannot be the patient's own physician. It should be someone chosen ahead of time and fully aware of a patient's end of life choices. It also needs to be someone who will stand their ground should opposing views arise.
A person's desires for end of life care absolutely should be put in writing. This includes choices made about CPR (restarting the heart and lungs if these organs cease to function), use of ventilators and blood, major surgery and dialysis. Whether or not to use artificial nutrition and hydration (giving food and water through tubes) should be specifically addressed.
New York state law is there to make sure a person's wishes are respected. It also allows a designated health care agent to make these decisions when a patient cannot. Forms to do this can be obtained through Auburn Memorial Hospital, all primary care physicians, lawyers or a statement can simply be written out. The form or statement should be signed, and two other adults should do the same as witnesses. This form should be given to the health care agent and the primary care physician. It can also be sent to AMH. The original should be kept where it can easily be found.
Peace of mind is afforded to the family members of a patient who makes their wishes and desires known while they are able to do so. Huge worries and burdens of guilt can be avoided and alleviated through this process. Have you taken care of this very important process?
For further information, contact the Human Services Coalition of Cayuga County
at 253-9743 or myself at
253-4536.
Dr. Geer is a general surgeon in Auburn with a special interest in breast surgery. She is also an ordained chaplain.
It is truly a gift given to loved ones when a person makes their end of life decisions clear long before the need for such directives ever arises. There is then no guessing, and a huge burden is removed from family members at a very stressful, emotional time.
Making wishes for care known before the crisis occurs also helps to assure that a person gets the care they want. The ethical principle covering this is called personal autonomy. It means making personal decisions based on one's own values, beliefs, desires and best interests.
Most Americans find it hard to discuss end of life issues. It is uncomfortable to talk about death and certainly not the usual dinner table conversation. However, not having such discussions may mean a person does not receive the treatment they would want.
Some of the topics families should discuss are:
• Living arrangements when someone can no longer care for themselves
• Quality of life versus quantity of life
• What kind of medical care is wanted at the end of life
• Should medical care ever be withheld, even if it would allow a person to live longer?
• What about artificial feeding? (feeding tubes or IVs)
(Remember, there are no right answers or opinions #- these represent an individual's own thoughts and feelings.)
If a person can't make their own health care wishes known (because of severe illness, Alzheimer's or a condition like a stroke), they can plan ahead and appoint someone to speak on their behalf. This person is called a health care agent, proxy or durable power of attorney for health care. A health care agent is there to make decision about medical care #- even to the point of stopping certain treatments. Obviously this must be a person both respected and trusted to convey a person's desires. The agent is an advocate for the patient, letting that person's wishes be known and adhering to the values important to that patient. There is no financial responsibility in being a health care agent.
A health care agent must be over 18 and cannot be the patient's own physician. It should be someone chosen ahead of time and fully aware of a patient's end of life choices. It also needs to be someone who will stand their ground should opposing views arise.
A person's desires for end of life care absolutely should be put in writing. This includes choices made about CPR (restarting the heart and lungs if these organs cease to function), use of ventilators and blood, major surgery and dialysis. Whether or not to use artificial nutrition and hydration (giving food and water through tubes) should be specifically addressed.
New York state law is there to make sure a person's wishes are respected. It also allows a designated health care agent to make these decisions when a patient cannot. Forms to do this can be obtained through Auburn Memorial Hospital, all primary care physicians, lawyers or a statement can simply be written out. The form or statement should be signed, and two other adults should do the same as witnesses. This form should be given to the health care agent and the primary care physician. It can also be sent to AMH. The original should be kept where it can easily be found.
Peace of mind is afforded to the family members of a patient who makes their wishes and desires known while they are able to do so. Huge worries and burdens of guilt can be avoided and alleviated through this process. Have you taken care of this very important process?
For further information, contact the Human Services Coalition of Cayuga County
at 253-9743 or myself at
253-4536.
Dr. Geer is a general surgeon in Auburn with a special interest in breast surgery. She is also an ordained chaplain.
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