Don’t wait until last breath

Making medical decisions before death eases family burden

A living will, a medical durable power of attorney and cardiopulmonary resuscitation directive are the three main advance directives used in Colorado. Enlarge photo

JERRY McBRIDE/Durango Herald

A living will, a medical durable power of attorney and cardiopulmonary resuscitation directive are the three main advance directives used in Colorado.

If vacationers leave their affairs in good hands for a short time away, it’s even a more prudent step for people preparing for their final trip.

Dr. John “Kip” Boyd, chief medical officer at Mercy Regional Medical Center, made this point Thursday when he spoke about advance medical directives at a Life-Long Learning Series lecture at Fort Lewis College.

The title of his presentation told it all: “Telling Medical Providers What to Do When You Forget What You Want Them to Do.”

Advance directives are written instructions a person prepares in advance of becoming incapacitated.

As background, Boyd said before the recent advent of life-sustaining dialysis, mechanical ventilation and intravenous feeding, people died within minutes, hours or days of being injured or falling sick.

But the ability to prolong life became the driving goal, even when there was no hope of recovery and the patient was incapable of making his or her wishes known, he said.

Ignorance of a patient’s opinion on end-of-life matters, and squabbles among loved ones about what the patient would want, complicated the situation, Boyd said.

The development of advance directives, of which three are available in Colorado, contributed to unsnarling such dilemmas:

A living will specifies whether life-sustaining treatment is to be withheld or withdrawn if the patient is terminally ill or is in a persistent vegetative state.

Medical durable power of attorney allows an appointed party to make decisions beyond terminal issues on behalf of the incapacitated person.

A CPR order is signed by the patient and his physician. It directs emergency or other providers to withhold cardiopulmonary resuscitation.

A wrist band or necklace with the words “Do Not Resuscitate” is encouraged, but not mandatory. But the order doesn’t mean not to relieve pain.

Boyd defined certain terms:

Persistent vegetative state: This can occur when a brain injury leaves someone with wakefulness without awareness. The condition can last for years with tube feedings.

Informed consent: A person, when still able to make decisions rationally, discusses risks, benefits and alternative treatments before making a decision.

The ability to make informed decisions regarding last wishes is critical, Boyd said. He recommended that even teenagers, because of sometimes risky behavior nowadays, have a medical power of attorney on file.

Rational, recorded decisions on end-of-life matters by the potentially incapacitated person relieve spouses, children, family and friends of a burden, Boyd said.

An ethical question – who has the right to say if life, even artificially sustained life, is worth living – arises when a person’s wishes aren’t known, Boyd said.

“It’s difficult if the wishes aren’t documented,” Boyd said.