Extraordinary Measures

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By Carolyn L. Rosenblatt, R.N., B.S.N., Attorney

Have you ever seen a healthcare directive, or “living will”? For most people who don’t want to be kept alive by artificial means at the end of life, the healthcare directive gives us a chance to spell out our wishes so that no one else will be confused about what we want when that time comes.

Here’s the bad news: doctors can’t seem to resist the urge to treat, prod, poke, test, call in other specialists, bill Medicare, and keep people alive, no matter what the healthcare directive says.

If anyone happened to see this week’s “60 Minutes”, the issue was addressed in its program examining the high cost of dying in our society. The point of the program is that we do have a choice about what is done to and with us at the end of life, as we should in a free society. But, the choice is often made for us without discussion, because of the failing of doctors to be straight with us and our families as to what is going on.

I believe that if you want to be resuscitated when there is no hope of surviving your fatal condition, that’s your choice, and it should be honored. However, if you choose not to be resuscitated, that choice should be honored, too. Rarely is it honored. The docs are too busy with keeping the beds full in ICU and using all their very expensive tools and diagnostic equipment.

If, as was shown on the “60 Minutes” piece, a terminally ill person has 20 specialists, all of whom are billing Medicare separately and for each and every thing they choose to do, it seems clear that for some, being kept alive artificially is an economic decision by the doctors and the hospital.

I’m an advocate for individual rights, and as such, I can personally testify to the fact that it takes very assertive behavior on the part of family to see that the dying person’s wishes are honored. You have to step in, stand up, and insist. It may be in the face of rather stiff resistance on the part of doctors.

Excuses will be made: “a miracle can occur”. “We haven’t given up hope yet”, etc. If the person is of very advanced age, all systems are failing, and there is nothing to do but prolong the moment of death, who are we kidding? We are all mortal, and it seems not only wrong, but utterly disrespectful of the dying person’s wishes to keep forcing treatment upon him or her when every doctor will admit that none of the treatment will change the outcome of the fatal condition.

This all assumes, of course, that the dying person has previously expressed a wish not to be kept alive by artificial means. For those who feel otherwise, this is not for you. But for many of us, myself included, I say, get out of the way.

The life cycle has a natural end. We have to deal with that. Trying to force the end to a point a few days or weeks later does not serve the dying person. It may serve the hospital budget. It may serve the egos of the various doctors to “do something”, rather than let nature take its course. But it does not serve us, as human beings who are supposed to have a choice in such things.

What’s the take-away here? If you don’t have a healthcare directive, get one. They’re free. If you do have one, let your loved ones know loud and clear what you want. Get your most assertive family member or friend to promise to take on the doctors and hospital when the end is near, if you can’t speak for yourself.

And let your doctor know that when the time comes, to please refrain from trying to stop nature. My doctor and I are going to have a little chat at my next visit. He may not be my doctor years from now, when I’m near my own end. But, I figure, it can’t hurt to practice the conversation.

Doc, if you’re taking care of me when I’m on my last legs, I want you to know something: I think it’s all right to die. Once you folks figure out there’s little time left, send me home. No ICU. No scans, no tests, no labs, no specialists. Pain medication if I need it, yes. Otherwise, just get out of the way, thank you. And let me go home to die in peace.

Ó 2009, Carolyn L. Rosenblatt, R.N., B.S.N., Attorney, AgingParents.com

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