Taking Responsibilty

It is the American way to defend “freedom” for anything and freedom to choose whether or not to do advanced directives is no different.  This is demonstrated by the fact that two thirds of all people do not have a “living will” (see statistics in America as stated in the Jacoby’s article called [Taking Responsibility for Death ]).  Patients are reluctant to make these major decisions for many reasons including political, religious, not understanding medical procedures. Sometimes, the patient simply does not want to face their own mortality.  Americans should take responsibility to make their end of life wishes known.  Advanced directives should be seriously considered much before The Patient Self-Determination Act is enforced upon entering a hospital.  In many cases, a patient’s indecision can result in financial or emotional disasters for loved ones left behind.  If advanced directives are made while the person is alert, alive, and coherent, then loved ones will be eased from some burden.

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A family member may accept being a health care proxy.  If a person agrees to this, that person should do exactly what the incapacitated person would have wanted as though she was capable of making the decision himself/herself.  It is important the proxy clearly understands the dying person’s wishes to the best of his/her ability.  If the dying person never appointed a proxy, the surrogate must act according to his/her best knowledge of what the other person wanted –even when it was never explicitly stated.  This includes acting within the legal means of the law.

In many cases, a patient will never be as familiar with medicine as their doctor considering how extensively the physician has been trained and educated.  There are some traditional areas that advanced directives concentrate on, though, which may guide people through the decision process.

  • The possible positive and negative outcomes of procedures including cardiopulmonary resuscitation, feeding tubes, ventilators, and dialysis
  • Questions about pain and comfort
  • The organ donation procedure
  • The use of antibiotics which may prevent death by natural causes
  •  Do not resuscitate and the possibility of possible negative outcomes such as persistent vegetative state, locked in etc

The patient should also feel confident that his/her wishes will be upheld in the event of sudden catastrophe such as an accident.  At the end of this discussion, the person should have confidence the doctors will be forthright and honest about futility analysis.

The patient and family should clearly understand any decision that may affect their own body.  They should indeed question anything they do not understand – at any time.  This may include why a medicine is being given; what are the side effects; is medicine necessary; is it recommended; will it prolong death;   People must communicate openly with the doctor or else we limit our options and may not be comfortable with our decisions.

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