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July 13, 2010 Print

Discussing Your Medical Wishes: A Patient’s Guide

by Carrie Gordon Earll

Discussing your wishes for medical decision-making in case you are ever unable to make your own decisions is an important task. This document will help you facilitate discussion with your loved ones on these difficult issues.

Talking with a loved one about your medical preferences in the event that you cannot decide for yourself is an important but rarely easy task. High profile situations such as the one involving Terri Schiavo remind us that an accident or illness could render any one of us unable to communicate our medical wishes. Planning ahead for such a situation will prove helpful to you, your family and loved ones.

“Advance Medical Directive” is an umbrella term that refers to written and/or oral directives you make about future medical care if you are unable to make your own decisions. This term includes a variety of documents; the two most frequently discussed are a “Living Will” declaration and a Durable Power of Attorney for Health Care.

The “Living Will” declaration is discouraged as it is a signed statement that attempts to predict your preferences in often complex future medical situations that you cannot foresee. The statement offers a narrow list of options that may be used to prohibit treatment you may want in a certain circumstance — even for a short period of time.

A Durable Power of Attorney for Health Care is encouraged as it allows you to name a trusted family member or friend to make medical decisions for you if you are unable to do so. It also permits you to name a secondary health care agent if your primary agent is unable to serve.

Signing a Durable Power of Attorney for Health Care is only part of the equation. You also need to discuss your general views, preferences and overall philosophy of medical decision-making with your health care agent. The following “discussion categories” may be useful to help you formulate a personal medical decision-making philosophy. It may also be used to facilitate conversation with the individual(s) named as your health care agent(s). Remember that your health care agent can only make decisions for you if you are incapacitated and unable to do so for yourself.

For more information on “Living Will” declarations and Durable Powers of Attorney for Health Care, see Advance Medical Directives

Note: This information sheet is not intended as a legal document such as a “living will” or to be legally attached to a Durable Power of Attorney for Health Care. Your health care agent may want to write notes on this page or a separate piece of paper during and after your conversation(s) for his or her personal reference.

Discussion Categories

This document includes the following “discussion categories”:

I: A Life-Affirming Perspective

II: Patient’s Prognosis

III: Possible Interventions

IV: Considering Various Scenarios

V: Additional Topics

I: A Life-Affirming Perspective

The writer of Ecclesiastes reminds us that there is a time for everything, including “a time to die” (Eccl. 3:1-2). Today’s life-sustaining interventions may appear to create a fine line between postponing death and sustaining life. When uncertainty exists, God invites us to ask Him for wisdom when we are in need of understanding and discernment in decision-making, including medical ones (James 1:5).

A pro-life philosophy on medical decision-making presumes intervention will be attempted to preserve a patient’s life as long as the intervention is determined to:

A) Be physiologically possible for the patient;
B) Offer an expected benefit without excessive risk or burden to the patient; or
C) Provide reasonable hope of sustaining or improving the patient’s life

For more, see What the Bible Says About the End of Life

II: Patient’s Prognosis

Your preferences regarding medical interventions and the use of technologies may vary depending on your age, physical condition, and the diagnosis and prognosis of your condition. Therefore, it may help to distinguish between the following categories when discussing your wishes with your health care agent:

Acute — short term, reversible medical condition with expected patient recovery

Disability — physical and/or mental loss or impairment, including neurological (brain) injury

Chronic — slow, progressive illness, disease or condition over an extended period of time

Terminal — irreversible and fatal illness, disease or condition

Actively Dying — imminently, in the process of dying due to a terminal illness, disease or condition

III: Possible Interventions

You may have different views and preferences regarding possible life-sustaining medical interventions. Here are a few to consider:

Antibiotic — a drug given to treat infection

Cardiopulmonary Resuscitation (CPR) — an emergency procedure to restore normal breathing and circulation after cardiac or respiratory arrest using mouth-to-mouth or mechanical assistance for breathing and external heart massage. Other medical methods commonly utilized during CPR include giving IV fluids and oxygen, infusions of antiarrhythmic or other cardiac drugs, electric shock delivered through a defibrillator (paddles placed on the chest), and intubation (placing tubes down the throat into the patient’s airway).

Dialysis — the process of using a machine to cleanse the body of impurities and waste when the patient’s kidneys fail to do so. It can be a short-term or long-term intervention.

Medically Assisted Nutrition and Hydration — the provision of nutrition (food) and hydration (water) to patients who are unable to swallow or digest normally. This can be provided by a flexible rubber or plastic gastric tube inserted into the stomach under local anesthetic at the bedside; it can also be provided intravenously or through a tube inserted through the nose. It can be a short-term or long-term intervention.

Surgery — an invasive operation or procedure to correct disease or injury

Ventilation — the process of using a handheld device for a short period of time or a machine called a ventilator or respirator for a longer period of time to help the patient to breathe

IV: Considering Various Scenarios

Section II offers a list of possible prognoses and Section III provides a list of possible interventions. Cross-referencing these two lists may be helpful in considering and discussing your personal views and preferences with your health care agent:

How do you generally view the following possible interventions if you are in an acute medical situation where recovery is expected?

Antibiotic
Cardiopulmonary Resuscitation (CPR)
Dialysis
Medically Assisted Nutrition and Hydration
Surgery
Ventilation

How do you generally view the following possible interventions if you are physically and/or mentally disabled, including neurological (brain) injury?

Antibiotic
Cardiopulmonary Resuscitation (CPR)
Dialysis
Medically Assisted Nutrition and Hydration
Surgery
Ventilation

How do you generally view the following possible interventions if you are chronically ill?

Antibiotic
Cardiopulmonary Resuscitation (CPR)
Dialysis
Medically Assisted Nutrition and Hydration
Surgery
Ventilation

How do you generally view the following possible interventions if you are terminally ill?

Antibiotic
Cardiopulmonary Resuscitation (CPR)
Dialysis
Medically Assisted Nutrition and Hydration
Surgery
Ventilation

How do you generally view the following possible interventions if you are actively dying?

Antibiotic
Cardiopulmonary Resuscitation (CPR)
Dialysis
Medically Assisted Nutrition and Hydration
Surgery
Ventilation

Bear in mind that patients’ preferences for intervention can change over time and with life experience. For instance, many disabled patients convey that an initial desire to refuse treatment disappeared after interactions with family and friends confirmed the value of their lives, even in light of disability.

V: Additional Topics

Related topics you may want to discuss include:

  • Being cared for at home, if possible, rather than in a hospital or long-term care facility.
  • Your views on the use of pain- and symptom-control measures including narcotics and sedatives.
  • Your views on the inclusion of palliative and comfort care offered through a hospice program.
  • Whether you want your age, physical condition, finances or other circumstances to play a role in medical decision-making.

For additional questions to consider, see “Making Medical Decisions for a Loved One: A Caregivers’s Guide

For information on hospice care, see Hospice Patients Alliance

This page was originally posted on December 16, 2003.

Carrie Gordon Earll is the Senior Policy Analyst for Bioethics at CitizenLink (an affiliate of Focus on the Family) and a fellow with the Center for Bioethics and Human Dignity.



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