Elisabeth Kubler-Ross wonders if the best application of modern medicine is for “prolonging life vs diminishing human suffering”. What is the right application of medicine? Is “doing whatever it takes” at the end of a life the right thing to do? What is suffering? What is quality of life?
Every individual has a different answer to these questions. One way to ensure that your preferences and beliefs about quality of life and about care at the end of life are known is to establish an Advanced Care Plan.
From NIH National Institute on Aging-Advanced Care Plan website:
“Advance care planning is not just about old age. At any age, a medical crisis could leave someone too ill to make his or her own healthcare decisions. Even if you are not sick now, making healthcare plans for the future is an important step toward making sure you get the medical care you would want, even when doctors and family members are making the decisions for you.
More than one out of four older Americans face questions about medical treatment near the end of life but are not capable of making those decisions. This tip sheet (below) will discuss some questions you can think about now and describe ways to share your wishes with others. Write them down or at least talk about them with someone who would make the decisions for you. Knowing how you would decide might take some of the burden off family and friends.
Advance care planning involves learning about the types of decisions that might need to be made, considering those decisions ahead of time, and then letting others know about your preferences, often by putting them into an advance directive. An advance directive is a legal document that goes into effect only if you are incapacitated and unable to speak for yourself. This could be the result of disease or severe injury—no matter how old you are. It helps others know what type of medical care you want. It also allows you to express your values and desires related to end-of-life care. You might think of an advance directive as a living document—one that you can adjust as your situation changes because of new information or a change in your health.”
Advance Care Planning is more than just a “do not resuscitation” order. It’s a way to express your wishes regarding:
Ventilator Use (breathing machine)
Nutritional Support (through an IV)
Comfort Care (such as for pain, constipation, anxiety_
It also allows for exploration of care within certain circumstances based on what makes life meaningful to you:
“You might want doctors to try CPR if your heart stops or to try using a ventilator for a short time if you’ve had trouble breathing, if that means that, in the future, you could be well enough to spend time with your family. Even if the emergency leaves you simply able to spend your days listening to books on tape or gazing out the window watching the birds and squirrels compete for seeds in the bird feeder, you might be content with that.
But, there are many other scenarios. Here are a few. What would you decide?
- If a stroke leaves you paralyzed and then your heart stops, would you want CPR? What if you were also mentally impaired by a stroke—does your decision change?
- What if you develop dementia, don’t recognize family and friends, and, in time, cannot feed yourself? Would you want a feeding tube used to give you nutrition?
- What if you are permanently unconscious and then develop pneumonia? Would you want antibiotics and a ventilator used?
For some people, staying alive as long as medically possible is the most important thing. An advance directive can help make sure that happens.”
For more information: