Throughout my life there have been decisions made for me, about me, and by me with that one simple word in mind.  In fact, a few months into my nursing education more than 20 years ago the word “viable” came into my vocabulary with regular frequency.

Webster defines viable as “capable of living”.  But who defines capability in that definition?

Throughout my nursing career, “viable” has taken on a multitude of professional and personal meanings which have affected me differently depending on my role (CNA, LPN, RN). The myriad nursing fields in which I’ve worked have given me as many perspectives:  geriatrics, psychiatrics, rehabilitation units, operating rooms, pediatrics, urology clinics, labor and delivery, home care and hospice.  I have cared for patients of all ages, from newborns to octogenarians.  In each and every one of these areas of my nursing career, the term “viable” demanded a different set of parameters in regard to my patients’ varied understandings of life and death … and mine.  What may seem viable to one person, may not be to another.  Capability to live may have as many variations.  The point is that we may each choose to define viability and capability in very different ways.

There is much discussion today about viable conditions, futile treatments, and quality of life.  I have often been asked by patients or their families about viability or futility of care and quality of life.  Looking back, there is only one great regret than I now recognize occurred much too often.  Those were the moments when patients and/or family members asked me to share what I have seen in others of similar situations.  Granted, there are restrictions placed on healthcare professionals that prevent us from sharing certain information with people not authorized to receive such information.  But, hindsight being what it is, I can see that there were times when patients and/or family members may have benefitted from me sharing knowledge and experiences gained over the years.  Perhaps the patient’s (or family’s) struggle may have been eased if I had shared my wisdom in some measured way.

I do know, however, that there were many moments that my experiences helped patients and their families:  helping patients understand the “what ifs” that were likely on their health horizon; alerting family members to the impending health changes of their loved one; and, honestly responding to a patient’s question of “what have you seen other patients like me experience.”  In my career, I have seen patients and families who want to know everything, and others who don’t want to talk about death.  And that’s okay.  Everyone should have the opportunity to talk if and when they want to share.

And everyone should have the opportunity to decide for themselves whether they are “capable of living”, whether their treatment course is a viable one, and when quality of life becomes more important than the number of days, weeks, months, or years remaining.

© 2013 Caring Choices