Why Advanced Directives are Important
Many people have specific ideas about how much and the type of care they want to receive at the end of their life. Unfortunately, many wait too long before creating and documenting these wishes – as well as identifying a person (known as a health care surrogate) responsible for making the decisions if the patient is incapacitated.
This story occurs all too often in our hospitals. A man suddenly becomes acutely ill and is uncommunicative. He’s rushed to the emergency room by ambulance, while his wife scrambles to get to the hospital. The patient’s condition quickly worsens. By the time his wife arrives, it has been determined that the patient will need to be placed on a ventilator — or he’ll die. His death appears to be inevitable, so this will only prolong his time in a hospital bed.
Who is going to make the decision to put the patient on a ventilator? The man had been crystal clear in his advanced directives that if he had a serious health event that was going to kill him, he wanted to be kept comfortable and have as peaceful a death as possible.
The man’s wife, who had been designated as the patient’s health care surrogate, couldn’t remember where the advanced directive was kept.
Unable to find the documentation, the hospital would have little choice but to put the patient on a ventilator. Over the next few hours the condition worsened, and the doctors determined that the patient had contracted pneumonia that spread to his bloodstream – causing kidney failure. He could be kept alive, temporarily, with dialysis, but even his prognosis was grim.
Fortunately, the financial planner was able to fax over a copy of the man’s advance directive and the documentation establishing his wife as the health care surrogate. Needless to say, it was a difficult decision for the man’s wife to tell the hospital not to use the ventilator or dialysis treatment – even though she knew this is what her husband would want. The patient died peacefully with his family by his side.
The challenge is for people be willing to have this difficult discussion while they’re well. The incentive is that a thoughtful, well-documented advance directive conversation can alleviate a lot of the stress of painful decisions that occur during a serious illness.