Written by: Dr. James Kelley
I remember sitting with my wife in an attorney’s office years ago to develop our living will and designate a “durable power of attorney for healthcare.” It all seemed like a fantasy exercise in “what if” scenarios since both of us were healthy with little thought to future possibilities of illness. I was probably like most people who undertake this task.
Most of us can’t conceive of or wish to imagine the possibilities of end-of-life care and decision making. Some, like me, go through the exercise and then file these documents away with the life insurance policy and other rarely viewed files. However, I personally have no excuse to neglect this important task since I rely on this information daily to make decisions in my practice of emergency medicine.
In the emergency department, we face end-of-life scenarios every day and are trained to recognize and treat critical illness. It’s surprising how often family members disagree on the last wishes of a loved one. Even patients under hospice care with advanced end-stage illness aren’t immune to an end-of-life debate between family members.
Trying to sort out the proper course of action can be made particularly difficult if an individual has no advanced directives or if these directives were drafted some time ago. The end-of-life debate is often fueled by assumptions, assertions and an extension of personal feelings that may not reflect the patient’s true wishes. In the absence of evidence to the contrary, emergency personnel typically assume you want everything done possible to preserve life and limb. Often, time is sensitive and critical in such situations and decisive action is required. Trying to run home and search the file cabinet for one’s directives is neither practical nor possible in most such situations. These are moments when families should be gathered together.
As an emergency physician, I recommend that families make a point to have a regular review of advanced directives and update their living will regularly to ensure that current wishes for end-of-life care are honored. Furthermore, designate an individual (family member or otherwise) to speak for the affected individual if they cannot, to communicate the most current end-of-life directives and serve as the chief surrogate decision maker. That individual should regularly meet with the patient and other family members to clarify wishes for end of life care.