The People’s Clinic: Maintaining dignity and caring for your family: What you need to know about end of life care
Consider this situation: you are driving home in a rain storm; you lose control of your car and hit a tree. You are taken to the hospital and need emergency medical attention. After the surgery, they determine that there is no hope of recovery, and you can only be kept alive by machines. What happens to you now? Would you choose to be kept alive artificially, or would you prefer to die with dignity? Unless you make your wishes known beforehand, you will not have a say. Your family will decide your fate without knowing what you wanted done.
Unfortunately in our society today, very little planning is done for the certainty of death. In the absence of documents stating someone’s preference regarding end-of-life issues, the person is vulnerable to the will of the physician, family, friends or other acquaintances. Alarmingly, only 11% of African Americans express their wishes regarding end-of-life care, compared to 38% of whites!
How Can I Ease the Burden on My Family?
Planning is required to protect your loved ones from uncomfortable situations and decision-making. Each adult should first decide what he or she would want to happen in the event that they are too ill to speak for themselves. Next, this decision should be clearly communicated with their family and physician. The key is to have the conversation before a crisis occurs. Talk about what you would like to happen in sudden situations such as an automobile accident, a heart attack or a stroke. Become familiar with and state your opinion concerning life-sustaining technology, including cardiopulmonary resuscitation and mechanical ventilation. Most importantly, understand that verbal communication is not enough in all situations.
What is a Living Will?
A living will is a written legal document that outlines your wishes related to end-of-life care. It allows you to direct healthcare providers regarding what you do and do not want them to do for you. The standard living will discusses your choice to be kept alive by: 1) intravenous fluids and nutrition, 2) a feeding tube, and 3) a mechanical ventilator (breathing machine). It addresses situations in which a person is terminally ill (has no hope for survival) or in a persistent vegetative state (is unable to communicate). If the physician certifies that you meet one of these conditions, then it is reasonable to rely on the living will as a statement of your wishes. If you are unable to speak for yourself but your situation is not terminal (there is hope for recovery), most living wills do not apply. This latter situation demonstrates why a living will alone is sometimes not enough to ensure that your wishes are honored; sometimes a healthcare power of attorney is necessary as well.
What is a Healthcare Power of Attorney?
You should discuss your decisions concerning end-of-life care with a person with whom you feel comfortable and trust to make medical decisions on your behalf. Appoint this person as your Health Care Power of Attorney (HCPOA). He or she will make healthcare decisions for you (the patient) whenever you are unable to make your own decisions or state your own opinion. While many people feel that having an HCPOA is always an end-of-life decision, consider the case of an automobile accident, which occurs without warning and leaves no time to make your wishes known. There needs to be one person assigned to speak with the healthcare professional on your behalf and answer questions regarding your care.
An HCPOA only goes into effect when you cannot make your own decisions. It may be revoked by the person who enacted it at any time. Therefore, if situations change (e.g. divorce or death of an assigned person) someone else can be appointed. If there is no assigned HCPOA, there is a common law progression of decision makers who take over. This starts with the husband or wife, followed by adult children, parents, and then brothers or sisters. Unfortunately, if an individual’s wishes have not been discussed with all the family members, each may have a different decision. This may result in chaos, anger, frustration and family division.
Remember: Both a living will and an HCPOA agreement must be signed in the presence of two witnesses and notarized. While this can be done at a lawyer’s office, public libraries also have blank forms, and there are many organizations that offer assistance in completing the forms and having them notarized.
Do you need further information, support or have questions or comments, about this article? Please visit www.agingwithdignity.org or contact us toll-free at 1-877-530-1824.
For information about the Maya Angelou Center for Health Equity, please visit: http://www.wakehealth.edu/MACHE.