Friday, October 9, 2009

Advance Directives

This is my paper that I submitted today for my writing class. A good part of it is my opinion on a part of the health reform that has been called "Death Panels." As you can see most people are under-informed about the current things in the health bill. I am one of them but I do support Advanced Directives. Please offer any counterpoints, opinions, and other things that I may of neglected to consider. (Compliments are also welcome, but specific is preferred)

Advance Directives Enhance Your Power to Choose

Advance directive consultations are good to have in the event that you face life-threatening surgeries or retirement age. Advance directives, also known as living wills, are specific instructions as to the care that the patient will receive when they are incapable of making decisions. Too often families face the expensive situation of making life and death decisions when a loved one is on life-support and shows no sign of recovery. Advanced directives are for those facing retirement age that care for their families. Living wills show their love for families by not forcing them into the burden of decision making. These consultations empower individuals to control their destiny in a manner that seems best for them. The advance directive visits with the health care professional provide the necessary information on health care options and the choices that may best suit the individual patient. Patients are given the opportunity to make an informed decision whether their families will be burdened with unnecessary bills and emotional stress. In the AARP Bulletin End-of-Life Counseling: Why It Really Matters noted medical doctor Bill Thomas of Ithaca New York, was quoted as saying, “The entire point of [advance directives] is thoughtful communication with a physician and creating some documents that can guide your care It’s so you decide”(Haederle).

If you do not have an advance directive prepared you may end up in a worse position than my grandfather during his final hospital visit. He was diagnosed with pulmonary fibrosis three years ago. This disease is caused by the scarring of the lungs and slowly reduces and destroys your breathing capacity. This past spring he was hospitalized and this proved to be his final hospital visit. Near the end of my grandfather’s life he had a machine that pumped air into and out of his lungs through a tube down his trachea so he could receive the necessary oxygen to live. He was stuck on life support with only one way to communicate his wishes, an almost imperceptible squeezing of your hand. If you asked my grandfather a direct question, such as “do you love me?” All he was able to do was squeeze your hand in response. When my grandmother faced the choice of whether to keep my grandfather alive, through machines, or let him go she asked him. My grandfather gently squeezed her hand telling her that he did not want to live his life through a machine and died shortly after they took him off life support.

Imagine yourself hooked up to a machine that causes you to breathe outside your own volition. This machine sits beside you slowly moving two pumps up and down. It is the only thing that keeps your lungs from collapsing. You have a small round tube filled with nutrient rich liquid that trickles into your body providing nourishment to sustain your bodily functions. Yet all you do each and every day is lay there. No chance for speech. No chance at recovery. No chance to live life as you had been during the past forty, fifty, or even sixty years of your life. In layman’s terms you are a vegetable. By vegetable I mean that your capacity to function as an independent person has diminished to the point that you can do nothing. The only thing doctors and nurses are able to do is keep you clean and ease any pain you might be in.

In the end my grandfather was able to decide his own fate. However, many people are not so lucky. They are stuck in this vegetable state while their families wishing and hoping that they may soon recover. Or they have Alzheimer’s or dementia and are no longer capable of making rational decisions. Their families are once again left to make decisions. The time for an advance directive has passed. The families are left with the burden. Most elderly would not want their families to have the responsibility of making this choice.

Advanced directives may cause the creation of living wills that allow a person to decide his or her own fate in a time of sound reason. This decision ought to occur while the choice is still theirs to make. That is why advanced directive consultations held by licensed medical professionals are effective. These enable a man or woman to the choice of every medical ability to help or DNR, which stands for do not resuscitate.

The family may object to the decision of DNR because they are not ready to experience the loss, because while the family member is still alive there is some hope of life. This concern is valid. The grief over losing a loved one is intense and strong. Yet this objection ought to be handled during what can be called the season of reasoning. This preparation will enable family members to gain an understanding for the family member’s decision and have time to prepare for the inevitable. We are all mortal and will eventually die. Most people want to have the choice. That is why advance directives ought to be made mandatory when facing retirement or major surgeries.

What may stop a patient from preparing an advance directive may stem from the fear that people are generally afraid to consider death as an eventual part of their life. I admit there is honest fear to fearing death but fear ought not to keep us from protecting those whom we leave behind. And helping us to live our life as comfortably as possible. Franklin D. Roosevelt on March 4, 1933, in his first inaugural address, said, “the only thing we have to fear is fear itself— nameless, unreasoning, unjustified terror which paralyzes needed efforts to convert retreat into advance.” We will have to admit we are mortal, that we will one day die. If we take that admittance and add advance directive preparation we may rest confident in knowing that our families will be taken care of after we pass away. That thought ought to be a comforting one. Let’s face our fears and visit with a physician about Advance healthcare directives.

It may be many remaining families and loved ones are left with a guilty conscience if they feel that they have not done all that they are capable of to ease a loved one’s death.

A living will not take effect in all situations unless the patient makes it so. The patients and their doctors can prescribe a set of circumstances that allow them to be made comfortable as they approach death. Or the living will come into effect only when a certain parameters are met. Whether those parameters are mental incapacity, organ failure, or severe wounds, the advance directive will dictate if and what kind of treatment will be administered. In the case of an unplanned accident an order of DNR may not be enforced, allowing all rescue efforts to be made.

In 2005 the average cost per patient per day in the hospital was approximately $1,500 to $1,600 (Project America). This cost does not seem too bad for a night’s stay in a facility where they ensure your health, relative comfort, and stability. However, these costs are those of a relatively healthy individual. If you were to include life support systems these costs could easy double or perhaps even triple. Then staying in the hospital hooked up to life support for days or even weeks you begin to see where the financial burden begins to pile up. An estimated cost of a three week hospital stay is $31,500 and that is at the minimum $1,500 per day. This brings the cost up to $63,000, double, or $94,500, triple, if you include life support for three weeks. This is the price of being a vegetable. This is the price my grandparents would have paid if my grandfather had not been able to make his choice. This would be a tremendous financial burden upon the family after the loved one’s death.

Having an advanced directive have and will empower a patient to choose the manner which they slip away into death. They will have made their own accommodations as to their comfort and ease. The patients were empowered to make an informed decision assisted by a physician as to their life. They have spared their families of guilty consciences and terrible financial stress. The patients who will do this will have an advanced directive. Do you?


Works Cited

Michael Haederle, (August 31, 2009). End-of-Life Counseling: Why It Really Matters, AARP

Bulletin. Retrieved from http://bulletin.aarp.org/yourhealth/policy/articles/end_of_life_counseling_why_it_really_matters.1.html

Project America, (2009). [Graph of healthcare averages from 1980 to 2005]. Health

Care: Hospitals: Cost per Patient. Retrieved from http://www.project.org/info.php?recordID=319