Advance Directive

[Gregory Matthews]

As a clinician, I am well aware that situation may arise in which a person may need to have prepared an Advance Directive, a durable Power of Attorney for Health Care and/or a Living Will.

The individual States each have  their own specific requirements and it is important that the above documents be prepared in compliance with the laws of each State.    With our move to California, I have decided that I need to update my documents in order to comply with the changes in our life situation.   These documents may run into several pages and they may contain multiple parts  which can be answered with simple check marks.  To stimulate your thinking, I will post below what I have written in  one of these documents.  It probably will not be exactly what fits your needs.  But, it should stimulate your thinking in regard to certain issues.  What I have posted below is only a part of a seven (7) page document.

 

Quote

I, Temple Gregory Matthews intend to state in this section my thoughts and wishes related to the Advanced Directive to which this document is a part..  It is also to be used as a guide in connection with Section A, Specific  Preferences About Life-Sustaining Treatments.   But, it is not limited to that.

In general, I believe that death is a normal part of life and that it is to be accepted as a part of life.  I also believe that “life” is defined more by quality than by quantity.  Therefore, I believe that there is a normal time to die for everyone and that death should be accepted.

Mechanical Ventilation:  I do not want to spend my life on mechanical ventilation when there is no reasonable hope of ever being able to breathe normally and I cannot be expected to have a quality life.   After thirty-three (33) days of mechanical ventilation, if there is at that time no reasonable expectation of a return to normal respiration and quality of life, I would expect that the mechanical ventilation would be withdrawn and the normal expected body processes would be allowed to happen.  But, I would want a trial period of mechanical ventilation.  I believe that thirty-three (33) days would be sufficient.

Cardiopulmonary Resuscitation:  I would expect that it would be done if there was a reasonable expectation of a return to a quality of life.

Kidney Dialysis:  My perspective is that people can have quality of life while on kidney dialysis.  Therefore, if I could be expected to have quality of life, I would expect that I would be given kidney dialysis.

Artificial Nutrition & Hydration:  If able to give  consent, I would expect that my wish either to receive or not to receive would be followed.  If not able to give consent, I would expect that decision to be made on the basis of quality of life.

[Gregory Matthews]

NOTE:  On a personal basis, I may be covered for the above under Federal law.  The above document was a Federal document and for anyone who wants to view such a document it is VA Form 10-017, November 2016.

That document is available on the Internet may give you a better picture of what is involved in such documents.

 

[rudywoofs (Pam)]

How did you come up with "33 days" on a vent?  That seems like a long time in ICU or CCU, where you'd most likely be if you're on a vent.

[JoeMo]

8 minutes ago, rudywoofs (Pam) said:

How did you come up with "33 days" on a vent?

I know people who have lived several years on a vent.  Although I don't know him personally, Charles Krauthammer (Fox News) is a quadriplegic and has lived quite a while in a vent.  As the brother of a quad, I know several people who have lived quite a while on a vent (some for over 35 years).  Many lung or throat cancer survivors live on a ventilator.  Usually patients who are on a vent long-term have tracheal vents, which are much more tolerable than a tube down the throat.

[Gregory Matthews]

How did I come up with 33 days?

*  Personal observation of the life that a person has who is on a vent.

*  A close relative who spent 30 days in a coma and on a vent and then came out of it and lives a very active life today.

Just a personal choice that I have made and I do not  suggest it for anyone else.  My post is simply to stimulate people to thinking about the decisions that they may need to make and if they do not make them, others may make them.

 

 

[B/W Photodude]

You can go beyond 33 days and seemingly will never recover. However, I have transferred many people out of intensive care units in a vegetative state after weeks in the ICU, and weeks on a ventilator, only to have them come back later to visit (and these were the most delightful reunions you could imagine). Many people also may be on dialysis in the ICU and will not necessarily be dialysis dependent for life. Obviously, you really need the input of realistic physicians in decision making and time alone is not really an indicator for the potential of returning to a normal life. Some physicians believe they will save every one of their patients and this leads to serious disappointment for families when it doesn't turn out well. Other physicians are more than average pessimistic which strangely enough leads many families to have a happy ending and believe they have beaten the docs and the system!

There are so many factors going into a life threatening event that it is really hard to make up the paperwork ahead of time to really cover the possibilities. Giving a trusted other person power to make to decisions for you can give the situation the flexibility to respond to whatever comes along. This does make it difficult on the person given the decision making power some stress as many are afraid of making the "wrong" decision. I used to tell people there is no really right or wrong choices, but that the person unable to decide for themselves is just trusting that the person making the decision would do their best for them. There are too many uncertainties in healthcare to really know for sure that you have made the "right" decision. Unfortunately, people have been conditioned to believe that cures for almost anything are just over the horizon.

[rudywoofs (Pam)]

yes, yes, yes, yes, yes, yes, yes, yes... I understand that many people live well beyond 33 days on a vent.  

**sigh**

Ya'll missed my point.  Forget it...

[Gregory Matthews]

There are many aspects of this issue.  There are often no easy answers.  The documents that I mention at the beginning of t his thread do not lock things into concrete.  But, they give family and those who provide care an indication of what the patient might want and they set people in place who the patient desires to make decisions for them.

I posted to stimulate thought, as expected, I seem to have done so.