Having a firm Advance Directive is one of the most important things you can do to ensure your end-of-life wishes are honored. But it can be tricky to obtain the right document(s) you need.
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It’s a pillar of the RTD movement, that we treat our suffering pets more humanely than suffering friends and family members. “Let me die like a dog” has long been a call to compassion. The author went through the agonizing decision to “put down” a beloved canine companion, and he regrets not knowing what “Woody” would have wanted.
“Sleep deprivation amplified every emotion and wore me down quickly,” she said. She was exhausted, angry, and felt guilty. She was “flying blind” to be the surrogate as Betty neared death – and she was a trained, experienced hospice RN. What does that say about your chance of being an effective surrogate?
As discussed in Part 2, the SPIKES framework is useful to explore the family’s understanding of their loved one’s illness and to share information about medical condition and prognosis. When the purpose of a family meeting is to discuss goals of care, it may be useful to “unpack” care goals using the REMAP framework.
Just as for any medical procedure, conducting a meeting with families of seriously ill patients requires training and practice. Practitioners must develop skills in structuring serious-illness conversations and responding with empathy in emotionally fraught situations.
Timely, well-conducted conversations about goals of care in serious illness are associated with improved outcomes, including care aligned with the ill person’s values, less unwanted (and often expensive) care, improved satisfaction with care, and fewer mental health consequences for patients and families.
ZDoggMD (Zubin Damania, MD) explains in his engrossing style what it really means to decide that you want to be kept alive by doing everything possible. It may be time to remodel those advance directives.
One problem with advance directives is that often they are not honored. It is critical that you have a good advocate who demands that you get only the care you want and do not get what is not wanted, not only at end of life but at any time you encounter a medical institution. You will need to choose someone who meets the legal requirements to act as a health care or medical agent, which some states call a proxy, surrogate, or representative. I call this person your “advocate.” State requirements differ greatly, so be sure to use your state’s forms for naming a health care or medical agent, not generic documents like the “5 wishes.”
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