A strange story was in the news last week that I have been using as a talking point about end-of-life planning.
A deer hunter in his 40s fell 16 feet out of a tree and broke his neck. As a result, he could not breathe on his own and was placed on a ventilator. The doctors told the family he would be dependent on this device for the rest of his life. The family knew he likely would not make this choice if given the option.
So, he was awakened from his sedated state and presented with the situation. He ultimately decided that he did not want to live hooked up to a ventilator for the rest of his life, asked that it be disconnected and died a few hours later. I might have made the same choice.
This true story brings to focus the importance of having patients and their families consider, discuss and sign advance directives, medical power of attorney, and out-of-hospital do-not-resuscitate orders.
These legal documents should be executed in advance of a catastrophe, life-threatening illness or an event or disease that renders a person incapable of making their own decisions. A frank discussion of end-of-life treatment options and preferences for such things as hydration, nutrition, ventilation, cardiopulmonary resuscitation, antibiotics, tube-feedings, etc., doesn’t exactly make for great dinnertime conversation. However, such crucial conversations ought to occur while a person is fully able to understand the implications of their choices and to do so rationally.
End-of-life planning can be thought of in the same genre as drawing up a will or financial planning for retirement. In other words, routine.
At UTMB Health Family Medicine, we have started an initiative to increase the number of such discussions with our patients in our three clinics. We are doing this by educating our doctors, having posters in the exam room encouraging patients to inquire about end-of-life directives and putting the forms online in MyChart where they are easily retrievable and printable.
This advance directive conversation is often avoided because of a number of reasons, most of them based on false assumptions.
Doctors are already busy and in the short time we have in the usual office visit, it may be hard to bring up a sensitive subject. Just providing the forms for the patient to read doesn’t take long and questions could be addressed at a future visit.
Some folks have even told me they are superstitious about this issue and believe talking about it might cause them to get sick or die. Patients may also be in denial that such end-of-life scenarios could ever happen to them, particularly if they are younger and healthy.
Yet, consider the carnage during the recent bike rally. I would recommend those who ride motorcycles for fun, sport or work recognize that no matter how good a driver they are, it is still a high-risk activity.
High-risk occupations such as certain industrial settings, construction, mining, lumbering, cattle ranching, police, fire, and military duty all increase risk of on-the-job injury and even death. If you are in one of these, consider getting the advance directive executed, even if you are young and healthy.
What I have found in introducing this subject to my patients is that they are grateful for the opportunity to consider this important matter in their life and are pleased or even relieved that I brought it up.
The main thing is that we as health professionals respect patient autonomy and choice and that the patient understands the benefits and limits of what is medically possible. What kind of life are they willing to tolerate given their personal, cultural and spiritual beliefs?
Don’t procrastinate. Talk to your doctor and your family soon. Plan to live well, but also plan to die well.
Dr. Victor S. Sierpina is the WD and Laura Nell Nicholson Family Professor of Integrative Medicine and Professor of Family Medicine at UTMB.