Fall 2003 - Hospice of the Rapidan

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particular situation and many opinions on what constitutes life, but the most important thing is: if Terri Shiavo had created an advance medical directive, discussed it with her family, and kept it in a readily accessible place, this would be one less story for the media to sensationalize. Florida’s is not the only case in which a young person's family is suddenly faced with making decisions about his or her life, it is just visible at this time. A teacher of bioethics at the University of Pennsylvania, Glenn McGee notes that “almost no one between the ages of 18 and 30 has completed written advance directives for healthcare. But…80% of patients who are now in a persistent vegetative state are in this same age group.” There goes the idea that only old or terminally ill people need advance directives! Most people in America shy away from discussions of death as if denying its existence will preclude its arrival. Yet they'll spend years studying for a career, months planning a wedding, weeks decorating a room in anticipation of a new baby's arrival, and days organizing a vacation—all of them important events in a life, but arguably no less important than one's final event. As the dying character in Waltzing the Reaper remarks about the perceived morbidity of planning her funeral service the way she wants it to be, "how effective a funeral can I plan after I'm dead" According to a national survey, fewer than 25% of Americans have completed advance directives, about 20% haven’t even thought about end-of-life issues, and slightly fewer say they’ve thought about it but haven’t discussed it with anyone. The Basics Obviously, the first place to start with your own advance directive is to talk it over with your family. They need to know what your wishes would be in case you are ever unable to communicate. In addition to giving someone power of attorney for your financial concerns, you should also give someone medical power of attorney—and it may not even be the same person—who will understand and be willing to follow your decisions. Once you've signed your advance directive, make sure it's accessible! Don't lock it up in a safety-deposit box, or bury it amongst ten years' of tax returns—make sure the person you've selected as your medical proxy knows where to find it. Send copies to family members and your doctor, and have it
put on file at local hospitals (most of which will now ask you if you have one whenever you enter for elective surgery or other outpatient procedures, and encourage you at that point to fill one out). Shrink a copy and stick it to the back of your health insurance card—the one item you can be sure hospital and emergency personnel will go looking for. Start Thinking Invite the whole family to get together to discuss their end-of-life wishes. Use a high-profile case (even if you don't know any of the details except that somebody's in a vegetative state and the family's in a quandary as to what the person would have wanted) as a jumping-off point. Assure everyone that you aren't trying to be depressing or macabre, or trying to sneak a peek at possible inheritances, and that the whole conversation needn't be frightening. Propose a "what-if" situation that would result in a vegetative state, and talk about what each of you would like to have happen; how long, or if at all, to be on lifesupport systems, for example, if brain activity ceases. How do you feel about organ and tissue donation Would you want visitors Music Your pet Would you want to be read to, sung to, have your hand held, your feet rubbed Dr. Joanne Lynn, director of the Washington Center for Palliative Care Studies, suggests these stimulating questions: “If artificial feeding and hydration could get you over a tough spot until you could resume eating, and it could be stopped at any point if it isn’t helping, would you want it And, to what extent would you want health care providers to yield to the views of the family if they are contrary to the directive” For example, what if you said on your advance directive that in a persistent vegetative state, you would want no medications other than for pain. Sounds plain enough … but what if an antibiotic could cure something relatively minor, such as a bladder infection, and would make you more comfortable Be aware that health care providers are restricted in what actions they can take without authorization. Here's where discussion—ahead of time—with your family will help, just so they'll have a better idea of what your decision might be. A Little Help from the Pros
Page 1 and 2: Hospice Month Activities—Where Do
Page 3 and 4: Waltzing the Reaper is a one-woman
Page 5 and 6: As mentioned on the first page, a m
Page 7 and 8: From a patient’s family member:
Page 9: Note: A free workshop entitled "Cop
Page 13 and 14: Today, there are more than 40 milli
Page 15 and 16: Whether or not the weather cooperat

Fall 2003 - Hospice of the Rapidan

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