What are advance directives? What is a health care proxy?
In the United States, medical intervention is the norm. It has become an expectation on the part of both the consumer of health care, as well as the medical community. It is never a question that, whatever the cost, every blocked coronary artery needs to be stented, every malfunctioning cardiac valve needs replacement, every cardiac arrest needs resuscitation, every respiratory failure needs intubation, every abnormal shadow on an X-ray needs a CT scan, and every mass needs a biopsy. And so on…
It doesn’t matter if the recipient of the intervention is not capable of an improved quality of life as a result. Families and legal guardians of patients, who are not capable of consenting because of dementia, give the necessary consent.
As a result, there is an enormous cost, both physical and monetary, in the last few weeks of life.
While we are not moving away from all interventions, there is at least an improved awareness of the futility of cardiac resuscitation and the use of respirators in the setting of major medical debility. More people are providing “Advanced Directives” for how much intervention they would like to be done in the event of either Cardio-Respiratory Failure, or Brain Death.
These wishes should be discussed in advanced with the Family Doctor, as well as close relatives, so those wishes will be honored.
This is usually not a problem in the rest of the world, where the legalities and excessive intervention do not rule. However, with increasing prosperity, marketing and global access to information, there is a danger of losing the wisdom of pragmatism.
What is a health care proxy?
As long as you are able, you make your own medical decisions after discussions with your doctor. Sometimes an event or an illness may prevent you from being able to have a discussion or make a reasonable decision. E.g. a stroke, a coma, dementia, etc. Which of your friends or family members would you be able to depend on to make the right decision on your behalf? It is not always the “next of kin”. You can designate a person, but also let other family members know, so that there is no conflict, if the situation arises. It is better to have these conversations in advance, rather than in a crisis. It is not always comfortable to bring up these topics, and it is tempting to leave it to other people to figure it out if the time comes. Unfortunately, decisions made in a crisis are not always conflict-free, and it would make it so much easier on everyone, if a proxy is designated in advance.
Last week, I saw a Stage 1 breast cancer patient in follow up. She had completed her treatment and was doing well. But she thought it wise to discuss her advance directives with her daughters, and what she would like to do with her body, when her end came. I expect her to live to a ripe old age, but she’s doing the right thing.