Beyond a Vague Checklist

When I went to my doctor’s office for my annual medical appointment this year, I was met with a couple of topics that coincide with hitting the “Big 5-0”.  In addition to the regular taking of vitals and checking medications, it was suggested that I should do a few other things:  get a flu shot (done), consider a pneumonia shot (not interested), and, oh, yes, schedule a colonoscopy (yuk).   Of course, these are some of the preventative measures that we take to avoid getting knocked down by a virus or to detect one form of cancer in a treatable stage.  I confess – the idea of a colonoscopy produces a great deal of anxiety in me.  I am no doubt worrying about something that will probably not happen but the anxiety is there nonetheless.  And don’t even get me started about the stories well-meaning friends share about the prep!

One area that was presented in a hurried manner was the notion of an advance directive.  I sensed this wasn’t exactly a comfortable topic given the very general statement of something like … “Now that you’re 50, you should start thinking about an advance directive.”   Now, I did share that I’m pretty well versed in advance directives and that I have all my “paperwork” in order already.  I could sense quiet relief in not having to have a “death talk” as I happily took the form handed to me.  And there, the conversation ended.

The form I received is pretty basic … and rather vague.  The first paragraph notes that I am of sound mind and am voluntarily making this “declaration … if I become dependent”.  What does that mean?  Dependent?  In what way?  On whom? On what?  The next paragraph directs my attending physician to “withhold or withdraw life-sustaining treatment that serves only to prolong the process of my dying if I should be in an end-stage medical condition or in a state of permanent unconsciousness.”  Well, that certainly clears things up.

Then comes the checklist portion of the document, where one is supposed to actually check “I want” or “I do not want” in the boxes next to the inventory of items:

 (Please circle your response)
Cardiopulmonary Resuscitation (CPR) The use of drugs and/or electric shock to start the heart beating and artificial breathing  I want  I don’t want
Mechanical Respiration  Breathing by Machine  I want  I don’t want
Tube Feeding  Artificial, invasive form of food given through a tube in the veins, nose or stomach  I want  I don’t want
Artificial Hydration  Artificial, invasive form of liquids given through a tube in the veins, nose or stomach  I want  I don’t want
Blood or Blood Products  The use of whole blood or parts of the blood to replace blood lost  I want  I don’t want
Surgery  Use of any form of surgery to remove or repair any part of the body  I want  I don’t want
Invasive Diagnostic Tests  Tests that help reach a diagnosis by entering the body in some way, i.e., a tube inserted to look at the stomach, etc.  I want  I don’t want
Kidney Dialysis  Machine used to cleanse the blood of toxic waste   because the kidneys are unable to do so on their own  I want  I don’t want
Antibiotics  Medicine given to treat or prevent an infection  I want  I don’t want
Other:  I want  I don’t want

There is no statistical information that tells me how any of these things might be considered life-sustaining in my “dependent” condition.  There is nothing that explains risks and benefits of these items should I decide I want (or do not want) them.  This document does not provide specifics that will be helpful to my loved ones and my healthcare providers in making real-time, middle-of-a-medical-crisis decisions that will follow my wishes and provide me a peaceful death.

This is why personal conversations with those we love are so important.  The collective understanding that comes from discussions with those we love will carry more weight with healthcare providers than any piece of paper.  It will be important for spouses/partners, children, siblings, and closest friends to hear directly from us about the kinds of conditions for which we want treatment or not, and when we want them to let us go.

The approaching holiday gatherings with family can provide each of us an opportunity to begin these essential  conversations so that when the time comes, those we love will all know what to do and when to do it.  And we will know that they will be there to support each other and love each other after we are gone.  There is no greater gift to give this holiday season.

Let Caring Choices help you have your family conversation.  The first step is the most difficult to take, but you need not take it alone.

(c) 2013 Caring Choices