via shakesville, a hospice medical director shares the details of the end of life counseling that is being characterized as a death panel. i found it interesting, and there’s a resource for anyone wanting to set up their own directives. (PSA: think about organ donation!)
Mr. Jones, I’d like to talk to you about a dificult subject. I’d like to know if you’ve given any thought to how decisions about your health would be made if you were unable to make them. I ask all my patients this question – I’m not trying to sneak anything by you.
Are you asking about a living will?
A living will is one way to help make your wishes clear. As long as you can make your own decisions, the living will doesn’t matter. We’re talking about a time when you might not be able to help us decide what we should do. If we can talk about this now, I can help your family make those decisions if we’re ever in that situation.
I don’t want to be kept alive on machines.
OK, I understand that. But sometimes the machines only need to be used for a little while, and people can recover. If you needed a ventilator for 24 hours, and could recover completely, would that be worth it?
Sure. I’d do anything for 24 hours if I could get completely better.
That makes sense. What if you couldn’t get completely better? Some people feel that their life is worthwhile as long as they can communicate, even if they need a lot of physical assistance. Other people feel that they really need to be completely independent.
Well, as long as I can talk to my family and enjoy my food, that’s enough for me.
So if we can use medical technology to help you return to being able to talk to your family and eat, then it’s worth it?
OK. And of course we’d hope for a guarantee that we could do that, but more often we only know the chances. If we could use technology that had a 50% chance of leading to that kind of recovery, is that good enough?
Sure. 50% is a great shot.
What wouldn’t be a good enough chance?
I’d say 20%. If it’s less than a 20% chance, don’t do it.
So what I hear you saying is that if we can use medical technology to give you a better than 20% chance of recovery, you want us to go ahead.
Yes, that’s right.
OK. I don’t think you need to make a decision about the specific technology – it’s my job to help your family decide which interventions would meet your goals. As long as you can make your own decisions, then you and I will talk it over, but if it ever gets to the point where you can’t talk to me about it, this will help a lot.
Should I do a living will?
I think that’s a good idea. Have you talked to your family about this?
Well, my wife and I have discussed it a few times.
Do you want your wife to make decisions for you if necessary?
No, I think that would be too hard for her. I think my daughter would be a better choice.
Well, then I’d suggest you talk with both of them. If it would help, you can bring them in and I’ll talk to them, too. I’d also like to give you a copy of the Five Wishes, which will serve as both a living will and a Durable Power of Attorney, so you can write out your preferences and make sure your daughter will be able to do what you want.
OK, Doc. Thanks a lot. I’ve always kind of worried about being stuck on machines. I’m glad we talked about it.
I’m glad we did, too. If you have any other questions – or you change your mind about anything we discussed – let me know. And I hope it’s a long, long time before we need to make any of these decisions.