Welcome to Straight Talk on Health, I’m your host Dr. Chet Zelasko. Straight Talk on Health is a joint production with WGVU in Grand Rapids MI. I examine the world of health. Nutrition. Exercise. Diet. Supplementation. If there’s something new, I look at the science behind them, and let you know whether it’s real or not. You can check out other things that I do on my website Drchet.com and sign up for my free emails.
Time to get serious on this Straight Talk on Health podcast. This is about Advance Directives. What is an Advance Directive? Why should you have one? What’s involved? It all begins with a question, or rather, a series of questions. What kind of medical care would you want if you were too ill or hurt to express your wishes? Who would you want to make those decisions if you couldn’t? Advance directives are legal documents that allow you to spell out your decisions about end-of-life care ahead of time. They give you a way to tell your wishes to family, friends, and health care professionals and to avoid confusion later on.
There are generally two parts to an AD.
The first is a living will. That explains which treatments you want if you are dying or permanently unconscious. Don’t think that this is something just for your grandparents or parents. Think: what if you had an accident that rendered you unable to make decisions? A living will tells whether you will accept or refuse medical care.
What are some situations that might arise? You might want to include instructions on
The use of breathing or dialysis machines
Instructions on whether you want to be resuscitated if your breathing or heartbeat stops. Do you them to perform CPR on you? Do you want them to use a defibrillator to start your heart?
Instructions on tube or IV feeding. Do you want to be fed artificially through a feeding tube? If so, for how long? Do you want an IV for fluids? If so, for how long?
Do you want comfort care? The actual terms are palliative care and hospice. Hospice is intended to provide comfort to you and your family during a life-threatening illness. Hospice does not treat the disease in an attempt to cure it. My mother-in-law was in hospice for a week before she died. They were wonderful to her and followed up with all of us to see how we were dealing with her passing. Palliative care is similar but is offered with any other treatment you might be getting. The goal for both is to keep you comfortable. For many in this position, that means to keep you as pain-free as is possible.
Do you want your organs or tissue donated when you die? Maybe you wouldn’t mind being kept in a decomposition farm. That’s how forensic scientists learn about how the body decomposes.
Tough questions, aren’t they? That’s why it’s important for you to decide in advance. Understand, your decisions about how to handle any of these situations could be different at age 40 than at age 85. Or they could be different if you have an incurable condition as opposed to being generally healthy. And you always have the right to change your decisions as you get older or your health changes.
The second part of the AD is a durable power of attorney for health care. This document names the person who will be your health care proxy. Your proxy is someone you trust to make health decisions for you if you are unable to do so.
An advance directive allows you to provide instructions for these types of situations and then to change the instructions as you get older or if your viewpoint changes.
That’s what an AD is all about. Let me give you several examples that I’ve encountered both personally and in observation.
My first experience was with my mother. She died from lung cancer after smoking for 44 years. At the time, I was in my early 40s. My mother insisted that I become her health care proxy. Those were not talked about like they are today and I wasn’t sure all that was involved but I agreed. Her wish was that she have no extraordinary efforts to keep her alive if she had a terminal disease. As it turned out, it was also my first experience with palliative care as well. Her lung cancer was inoperable. She got radiation which shrunk the original tumor. As it turned out, the cancer had spread to the nerves of her spinal cord. She was in severe pain. They implanted a morphine pump and that controlled the pain.
But it wasn’t pleasant. Some people can’t handle morphine. She had all types of delusions. But it wasn’t long until she was unconscious all the time. That’s the time for decisions and I had to make them. Feeding tube? IV for fluids? She had said no, and in spite of what I might have wanted to do, she did not get them. She died a few weeks later.
Why did she insist on the health-care proxy? Because she had witnessed what had gone on with other family members. Those without HCP, and happened to have many children, would have terrible fights over what to do. Some would never talk with others again. She didn’t want that to happen.
The next time this came up was when my in-laws moved in with us in Grand Rapids. Paula felt that because they were getting up in years, with at least mom having several health problems, we should all get AD. So we did. I can remember several pages of questions that outlined many scenarios. Would you want X-treatment if this happened? How long would you want the treatment? On and on. Then, we all sat down with the lawyer one at a time to be sure that these were our wishes, and we signed them in front of outside witnesses. We also designated HCPs. Because Paula and I traveled a lot at that time, there was always the possibility that we could be in an accident together. So, our first choice was each other—naturally—but we both chose our son Matthew second if something happened to both of us. We have talked with him extensively about what we would and would not want. He understands our wishes and if the occasion should arise, will do them.
Have we needed them? Yes, for my MIL. She developed Alzheimer’s disease. The initial problem was that she had a severe reaction to a statin and it caused massive muscle damage. She never regained the use of her legs again. But she lived in a nursing home for a couple of years, and honestly, until the last two weeks were the best I’ve ever seen her. She loved it there, loved the people and they loved her. Dad used to visit every day. It was great although not ideal. But the staff and medical director had us come to a meeting. They were concerned that she was not eating well and recommended hospice care. Well, that meant they thought she was going to die, right? Not all the time. Sometimes the extra attention can help a person recover.
Not in this case. It wasn’t more than two weeks later that she went downhill fast. She had lunch with her table of women and by nightfall was in a coma. She died 5 days later. They made her comfortable with pain-killers but no feeding tube or IV. That was what she wanted and that’s what Paula told them to do.
I’ve explained the AD and my experience with them. The reason is that I want you to have the discussion with your parents and your spouse and children about getting AD. It’s not a happy-time discussion. People want to avoid it at all costs. But you should follow through and get the AD done properly and legally. Now. You can’t imagine the problems that can occur if something dire happens and you haven’t done it. My DILy is a respiratory therapist and has had to turn off breathing machines and has witnessed those fights first hand. But mostly, if someone has a HCP, you’re doing what the person wants and they’re doing exactly what you want.
Make sure that your lawyer has a copy as well as your HCP. Every time you go into the hospital, even for outpatient surgery, file a copy when you check in. They will ask you for it anyway if it’s like the hospital systems around here in GR. That’s it for now because I’m all out of time. This is Dr. Chet Zelasko saying health is a choice. Choose wisely today and every day
