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In search of a good death

Staff Reports

The case of Terri Schiavo has prompted a passionate and personal debate. If we can stop for just a minute and consider what we might learn from this tragic saga, perhaps some good can come from it.Advances in medical technology have allowed terminally ill and permanently unconscious patients to be kept alive much longer than ever before. About three quarters of Americans die in hospitals or medical facilities where overly aggressive treatment is common. Although surveys show that 90 percent of Americans hope to die at home, only 20 percent get their wish. The majority die in hospitals. Only 17 percent die in hospice care, where the focus is on keeping the patient comfortable rather than prolonging life. Many terminally ill people do not want aggressive treatment that merely postpones death, so there is a need for doctors, patients and families to make decisions about when a life should end. Advance Directives can help. What is an Advance Directive?”Advance Directive” is a general term that gives your doctor and caregivers instructions about your future medical care if you become unable to make medical decisions for yourself. In Colorado, the following kinds of advance directives are recognized: the Living Will, the Medical Durable Power of Attorney, the CPR directive, and Five Wishes. A Living Will (which applies only in cases of injury, disease or illness which is not curable or reversible and is judged to be terminal), is a document you sign telling your doctor not to use artificial life support measures, which will serve only to postpone the moment of death. In Colorado, your Living Will does not go into effect until two doctors agree in writing that you have a terminal condition. Two witnesses must sign your Living Will. The following cannot witness or sign a Living Will: patients in the facility where you are receiving care, any employee of that facility, any doctor or doctor’s employee, your creditors or people who may inherit your money or property. But here is the good news: a Lawyer is NOT necessary to draw up an advance directive, unless you have a specific legal question. A Medical Durable Power of Attorney is a document you sign naming someone (called a proxy) to make your health care decisions for you if you become unable to do so. A Medical Durable Power of Attorney can become effective immediately, or you can make it effective only when you become unable to make your own medical decisions. You can appoint anyone to be your proxy as long as that person is at least 18 years old, mentally competent and willing to be your agent. Cardio Pulmonary Resuscitation (CPR) Directive allows you or your proxy to refuse resuscitation. If you have a CPR or DNR (Do Not Resuscitate) Directive and your heart and/or lungs stop or malfunction, then paramedics and doctors, emergency personnel or others, will not try to press on your chest or use breathing tubes, electric shock or other procedures to get your heart and/or lungs working again. DNR orders are written by a physician when, in a physician’s judgment, and after consultation with the patient and/or proxy, resuscitation would not be appropriate. The Five Wishes document lets your family and doctors know:1. Which person you want to make health care decisions for you when you can’t make them.2. The kind of medical treatment you want or don’t want.3. How comfortable you want to be.4. How you want people to treat you.5. What you want your loved ones to know.It is important to note that you may cancel or change an advance directive at any time. However, you should inform your family, your doctor, your proxy and anyone who has copies of these documents that they have been cancelled or changed.Advance-care medical planning is more common now than it was five years ago. But more people should be doing it. Some people wait until they are hospitalized, but a sudden illness such as a stroke may make one too ill to execute an advance directive just when it is most important that it be in place. Do not complete an Advance Directive before you are sure what you want it to say, and discuss your responses with your physician, family and proxy. Try to be as specific as possible review your advance directives regularly and make sure they express your wishes clearly. Keep a card in your wallet stating that you have advance directives (and where to find them). Give a copy to your physician to be kept as part of your medical records and also give copies to relatives or friends and proxies who are likely to be notified in an emergency. Most important, keep one available in your place of residence. It should be mentioned that, in Colorado, if there are no advance directives in place, decisions are made by “a consensus of interested persons.”You can download state-specific advance directive documents at nhpco.org, and apply for the Five Wishes document at agingwithdignity.org. You can obtain a free copy of the pamphlet “Your Right to make Health Care Decisions,” which includes forms for a Living Will and a Medical Durable Power of Attorney at cha.com. VTDaphne Slevin is a long-time local and a member of the Mountain Hospice Voluntary Advisory Committee. She can be reached for comment through The Vail Trail by writing Tom Boyd at tboyd@vailtrail.com.


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