As a caregiver, I’ve come to realize that most people simply don’t comprehend how difficult it is to watch a loved one die, how gut wrenching it is to see her lying in bed with no hope of recovery and have to say “give her more pain medication” or “no, don’t try to save her life.”
The kindest thing we can do for our loved ones as we approach the end of our lives is to make our wishes known in the clearest, most detailed – and legally binding – manner possible.
While most people have heard of a DNR (do not resuscitate) order, few really understand what it does and doesn’t mean. Specifically, a DNR tells health care providers that you don’t want CPR (cardiopulmonary resuscitation) to be performed if your loved one’s heart stops beating. A DNR doesn’t prevent other invasive procedures from being performed.
You might wish to execute additional orders to clarify your wishes. “Do not intubate” and “do not hospitalize” are some common ones. Intubating involves inserting a breathing tube into the patient’s throat to improve respiration.
If the patient is terminal, the family may opt for a broader “comfort care only” order. This kind of order stipulates that the patient only be offered services that will ease her suffering and make her more comfortable. This is also referred to as palliative care.
Comfort care only doesn’t mean the patient will be neglected. The patient will still receive pain medication and be kept clean and dry. Invalids will be repositioned frequently to prevent skin break down. Those who can eat without proscriptive risk of choking or aspiration will be fed.
A living will is a more comprehensive legal document used to detail the patient’s wishes for end of life care. A DNR and other orders may be included as part of a living will. The living will is most commonly used to communicate whether or not an individual wishes to be placed on a ventilator in the event she cannot breathe on her own. It may also be used to communicate the patient’s wishes regarding feeding tubes or dialysis.
The tricky part of making end of life decisions is that many of the most difficult ones occur after the patient is no longer capable of making them for herself. In the early stages of a disease like cancer or Alzheimer’s, CPR may make sense, but as the patient’s health falters and quality of life declines, CPR may no longer seem appropriate and can in some cases be more dangerous than beneficial to a fragile patient.
Power of Attorney
It’s impossible to anticipate every aspect of an individual’s decline, for that reason it’s important to choose one person to make decisions about the patient’s treatment in the event she can no longer speak for herself. A medical power of attorney (POA) gives a designated person the right to act as the patient’s medical agent or proxy.
Setting up a POA is especially important in situations where the patient’s family may not agree with the patient’s wishes regarding her treatment or where the family is divided on the subject. It also allows the patient to choose someone who is not a relative.
When setting up a POA for end of life decisions it’s important that it be a “durable” POA, meaning that it will continue to be in force after the patient becomes incapacitate. A durable POA takes effect as soon as the document is signed.
If the patient is still capable of making her own decisions when the document is executed, she may opt for a “springing” POA, which springs into effect only when she becomes incapacitated.
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