What Say You? Dignity,
Autonomy and the Advance Directive
SUSAN CLOKE
Columnist, Santa Monica Mirror
Dr. Jonathan
Weaver, a member of the medical staff at Saint John’s Health Center, believes “communicating ones wishes for
treatment at the end of life is one of the most important discussions you can
have. This can be a conversation
with your physician or with your spouse or any person you designate to be your
advocate.
He continues, “It
is a discussion that is not frequently done and in fact only 30 percent of physicians
polled have communicated their wishes with their own doctor
regarding end of
life care.”
Dr. Weaver will discuss
a practical approach on how to conduct end of life decisions with your doctor
and how doctors approach end of life care for themselves at the St. John’s
panel discussion on “End of Life Care.”
Santa Monica Main Library April 16 2-4 pm and April 17 6:30-8:30 pm. (For reservations call 310829 8453)
Other panelists
and facilitators include: Ross
Kino MD, Medical Director, Emergency Services; Brian Madden MD, Medical
Director Palliative Care; Nancy Parks, RN, Palliative Care Nurse Coordinator;
Cynthia Lane, RN, Director Case Management and Social Services; and Paul
Schneider, MD FACP, President, Southern California Bioethics Committee
Consortium.
Why care about this? If you want the physician and the medical staff to respect
your wishes when you are in the hospital, if you are unexpectedly in an
accident or become severely ill at a young age, if you are elderly and have an
illness or a disease, if you want your health care values and beliefs to be
respected, it is worth it to care.
An example of when it’s important to have your
wishes known ahead of time is with CPR (cardiopulmonary resuscitation). When you hear someone talk about CPR is
your image one of a TV actor playing a buff lifeguard pushing on a swimmer’s
chest and administering mouth- to -mouth resuscitation restoring the swimmer to
breath and life?
That is one kind of CPR. In the hospital a patient with no
heartbeat might need in hospital CPR where their ribs are cracked and the rib
cage opened so the heart can be accessed directly. Emergency or operating room CPR saves lives and is an
essential protocol in the hospital.
But is it always the right thing to do?
Is the patient fundamentally healthy but has
stopped breathing due to a trauma and can be restored to health or was the
person in a serious auto accident, having no discernable heartbeat, and with
irreversible brain damage causing the loss of cognitive capacity? In these completely different scenarios
the patient, or the patient’s advocate, must direct the physician.
Physicians make medical decisions and offer
medical advice. Patients have the right
to autonomy and the right to accept or reject medical care based on their own
health, their values and beliefs.
So how do you keep your autonomy even if you can
no longer speak for yourself? One
way is through an Advance Health Care Directive informing physicians of your
health care decisions. Another is
to authorize a person to be your advocate when you can’t speak for yourself.
If only 30 percent of doctors think this is
important, why should the rest of us?
We have learned form the Johns Hopkins Precursors Study (a longitudinal
study following Johns Hopkins trained physicians) that doctors often “forego
the same end of life treatments they offer to patients.” (Doctors Die Differently by Arline
Kaplan June 29, 2012 Psychiatric Times)
Ken
Murray MD, a Clinical Assistant Professor of Family Medicine at USC and one of
the physicians in the Hopkins Precursors Study, is the author of the Zocalo
Public Square essay “How Doctors Die: It’s Not Like the Rest of Us, But ItShould Be”
He
writes, “It’s not a frequent topic
of discussion, but doctors die, too. And they don’t die like the rest of us.
What’s unusual about them is not how much treatment they get compared to most
Americans, but how little. For all the time they spend fending off the deaths
of others, they tend to be fairly serene when faced with death themselves. They
know exactly what is going to happen, they know the choices, and they generally
have access to any sort of medical care they could want. But they go gently.
“Of
course, doctors don’t want to die; they want to live. But they know enough
about modern medicine to know its limits. And they know enough about death to
know what all people fear most: dying in pain, and dying alone. They’ve talked
about this with their families. They want to be sure, when the time comes, that
no heroic measures will happen–that they will never experience, during their
last moments on earth, someone breaking their ribs in an attempt to resuscitate
them with CPR (that’s what happens if CPR is done right).
“Almost
all medical professionals have seen what we call “futile care” being performed
on people. That’s when doctors bring the cutting edge of technology to bear on
a grievously ill person near the end of life. The patient will get cut open,
perforated with tubes, hooked up to machines, and assaulted with drugs. All of
this occurs in the Intensive Care Unit at a cost of tens of thousands of
dollars a day. What it buys is misery.
“If
there is a state of the art of end-of-life care, it is this: death with
dignity. As for me, my physician has my choices. They were easy to make, as
they are for most physicians. There will be no heroics, and I will go gentle
into that good night.”
Dr.
Murray is clear about his values and has communicated them to his physician and
has shared them with us. For
everyone, getting to clarity takes some work. Hearing from medical professionals might just be a good way
to get started in figuring out your own beliefs and values.
What
Say You?
