Advance Medical Directives

Jul 21

Five Wishes

Five Wishes is an advance directive created by the non-profit organization Aging with Dignity.

The advance directive contains two legal documents, which are the Health Care/Medical Power of Attorney and the Living Will. However, the document also addresses matters of comfort care, spirituality, and final wishes.

According to the American Bar Association’s Commission on Law and Aging, Five Wishes currently meets the legal requirements for an advance directive in 42 states and the District of Columbia. In the remaining 8 states, (Alabama, Indiana, Kansas, New Hampshire, Ohio, Oregon, Texas, and Utah) a statutory form is required, and one must attach the state document if one wishes to use the Five Wishes document as a guide.

Here is an outline of the Five Wishes document:

Wish 1: The Person I Want to Make Care Decisions for Me When I Can’t
In this section, you create a medical / health care power of attorney. You choose a health care agent. This person makes medical decisions on your behalf if you are unable to speak for yourself.

Wish 2: The Kind of Medical Treatment I Want or Don’t Want
In this section, you create a Living Will. You define what life support treatment means to you, and when you would and would not want it.

Wish 3: How Comfortable I Want to Be
In this section, you address matters of comfort care. This includes the type of pain management you would like, personal grooming and bathing instructions, and whether you would like to know about options for hospice care.

Wish 4: How I Want People to Treat Me
In this section outlines personal matters, such as whether you would like to be at home, and whether you would like someone to pray at your bedside.

Wish 5: What I Want My Loved Ones to Know
In this section you discuss matters such as forgiveness, how you wish to be remembered, and final wishes regarding funeral or memorial plans.

If you would like to know more about Five Wishes, please see the website.

Jul 17

Face it, Embrace it, Defy it, and Conquer it!

This morning, Pastor Joel Osteen told the most amazing story. It was the story of Victoria Arlen.

Victoria was active and healthy until she was eleven years old, when she developed a pain in her side. Her doctors removed her appendix, but that didn’t help.

Victoria’s health continued to deteriorate. She lost 30 pounds in just three weeks. Her arms and legs stopped working. She lost the ability to speak, eat, and walk. Eventually she became unable to move at all, and slipped into a vegetative state.

Victoria was diagnosed with a rare autoimmune disorder that was causing pressure on her brain and spinal cord. Victoria’s doctors told her parents that she was unlikely to survive. If she did survive, they believed that she would live her life in a vegetative state.

Two years later, Victoria “woke up” and became aware of what was going on around her, although she remained unable to speak or move. Eventually she was able to open her eyes, and began to recover.

In 2010, four years after her diagnosis, Victoria returned to school. She was paralyzed from the waist down, but grateful for her recovery. She was told that she would never walk again.

In March 2016, Victoria defied the odds again, and took her first steps. She can now walk normally, and no longer needs a wheelchair or even crutches.

Today, at age 21, Victoria Arlen is one of ESPN’s youngest on-air personalities! She is also an actress, a model, and a motivational speaker!

You can learn more about Victoria Arlen on her website at VictoriaArlen.com

Keep Victoria’s story in mind as you prepare your Advance Medical Directives.

Jul 13

Tragedy To Triumph

Amy Purdy was 19 years old when she started having flu-like symptoms one day. The following day she was in the hospital on life support with a 2% chance of survival.

Amy had contracted bacterial meningitis. She went into septic shock less than 24 hours later. Both of her legs had to be amputated below the knee. She lost both kidneys, and her spleen had to be removed. She also lost all of the hearing of her left ear.

Amy beat the odds and recovered. She challenged herself to move on with her life, and to reach goals that anyone would struggle to achieve. She became one of the top ranked adaptive snowboarders in the world.

In the spring of 2014, Amy inspired millions of fans with her performances on ABC’s Dancing With The Stars. During the 2015 Super Bowl, she was featured in a commercial for Toyota. Later in 2015, her book “On My Own Two Feet” became a New York Times best-seller. Currently, she is a motivational speaker who is invited to share her wisdom with audiences around the world.

I love Amy Purdy’s story! We never know what the future holds for us. How we prepare for it, and respond to it, is up to us.

One way to be prepared for unforeseen critical illness is to ensure that your Advance Medical Directives and Powers of Attorney are up to date.

Jul 09

The Story of Colby Cassani

In 1993, Colby Cassani, who was only one year old, was left unattended in a bathtub by his babysitter. He slipped under water and drowned. He was rushed to the hospital, but his life could not be saved.

A physician at the hospital asked Colby’s parents the difficult question: “Would you be willing to donate your son’s organs?” In spite of their grief, they agreed.

Although Colby’s life was short, his legacy touched many lives. His kidneys were transplanted into a twenty-seven year old man. His liver was implanted in a two year old girl. And his heart was donated to a five month-old boy. All of the transplants were successful.

The Cassanis established the Colby Foundation in 1995 as a way to honor Colby’s memory and to inspire and educate others about organ and tissue donation. You can read more about the Colby Foundation at www.colbyfoundation.org.

Almost anyone can be an organ donor, regardless of age or medical history.

You can make a statement regarding organ and tissue donation in your Living Will, on your driver’s license, or in a separate document. You can also give specific direction as to who should benefit from the donation, and may even give certain individuals, such as family members a preference.

Jul 08

Being Mortal

Yesterday I discussed “Do Not Resuscitate” orders, and explained what they are.

One of the most touching stories I have ever heard about a “Do Not Resuscitate” order was told by Dr. Atul Gawande in his best-selling book, Being Mortal.

Dr. Gawande is a nationally recognized surgeon. His father, who was also a surgeon, was diagnosed with inoperable cancer when he was in his early 70s. Although everything possible was done for Dr. Gawande’s father, his condition deteriorated to the point that he was confined to bed. He was adamant that he did not want to be in pain, and did not want to be resuscitated.

Dr. Gawande’s father eventually began to receive hospice care at his home, and was given medications for comfort. Dr. Gawande’s mother, who is also a doctor, stayed by his side. However, when she couldn’t wake him up and his skin began to turn blue, she panicked and called 911. When Dr. Gawande’s father woke up in the hospital, he was furious!

This story illustrates the conflicts associated with “Do Not Resuscitate” orders and end-of-life decisions. Even doctors are not immune to the strong emotions they incite.

I highly recommend the video Being Mortal, which was aired on PBS in 2015, and in which Dr. Atul Gawande discusses end-of-life issues in detail.

Jul 07

What Is A “Do Not Resuscitate” Order?

You have probably heard of CPR, or Cardio-Pulmonary Resuscitation. If your heart stops beating or you stop breathing, Cardio-Pulmonary Resuscitation procedures are done to save your life.

As a former hospital critical care nurse who has seen many patients resuscitated, and then kept alive for months on life-support in a comatose or vegetative state, I have very strong feelings about “Do Not Resuscitate” orders. For many patients, resuscitation was a great disservice to them, and only prolonged the dying process.

We tend to associate “Do Not Resuscitate” orders with elderly people who are terminally ill. However, they are appropriate for anyone with an end-stage terminal illness, including young cancer patients, and even terminally ill children.

Unlike a Living Will or Medical Power of Attorney, which are documents that you sign for yourself, a “Do Not Resuscitate” order must be given by your doctor after a consultation. If your doctor does not give a “Do Not Resuscitate” order, medical personnel must administer CPR.

If you have a “Do Not Resuscitate” (DNR) order, you should display it on the front door of your home or on the refrigerator, so that emergency medical personnel can find it easily. If you are a patient in a health care facility, your doctor will put a “Do Not Resuscitate” (DNR) order on your chart.

Like all advance medical directives, a DNR order can be revoked at any time. They do not apply to other kinds of medical care, such as treatment for pain, bleeding, or broken bones. They only apply to resuscitation procedures, like chest compressions and breathing tubes.

If you, or a loved one, is facing a life-threatening illness, I highly recommend the video Being Mortal, which was aired on PBS in 2015, and in which Dr. Atul Gawande discusses end-of-life issues in detail.