Designating someone to be your decision maker when you are incapacitated is a very important decision. In a previous post, I discussed how it is important to designate a durable power of attorney (DPOA). You might think that the person you are closest to should be the obvious choice. For example, a spouse or child or sibling. Most of the time, this is the case, but you do need to be thoughtful about whom you designate. The person you choose should know you WELL. They should also be able to separate their own desires and needs from what they should know would be your wishes. You cannot ever assume that your DPOA knows where you stand in regards to issues of resuscitation, feeding tubes and other unexpected medical decisions that may need to be made. I have seen too many times where your designated DPOA acts as “they (themselves) would want to be treated” and not necessarily how you yourself would’ve chosen to be treated.
A good way to try and make the best decision for your loved one if you have never had a “formal discussion” with them is to imagine if your loved one were standing next to you and were able to see himself/herself lying there right now…ask yourself what would he/she tell you to do for them? I have heard a range of responses. : “That stubborn bastard would want me to do everything possible to keep him alive……even though that’s not what I would want”. Other responses are a bit more heartfelt: ” She would absolutely tell me that if God were ready to receive her that she is ready to go…she didn’t want to be a burden to me…but I always tell her she is not”. In both of these cases we try and project what we would want for our loved ones….when the answer is right before our eyes. What would THE PATIENT, your loved one, want? A DPOA should act as the person would for themselves. Push away any guilt, fear, anger or love…and do your job. Be the voice of the patient who is lying in bed and can’t speak for himself./herself.
A funny story comes to mind. I was meeting with a couple who had been married for over 50 years. They had designated each other as DPOA but they never really talked about what each other’s wishes would be in case of an unexpected health crisis. The wife was my patient. She had recently been hospitalized and had been on a ventilator (breathing machine) for almost a month. When she was taken off the ventilator, rather than being relieved and thankful for recovering from her pneumonia….she was angry with her husband. She had never wanted to be connected to a ventilator and she made it clear to me (with her husband present), that should her lungs fail again…that she would not want to be intubated. She wanted a Do Not Resuscitate (DNR) order placed on her chart. He was so surprised because he thought that she would be grateful that he had made the decision to “save her life”. I sat next to the couple as they discussed their wishes. The husband’s wishes were quite the opposite to his wife’s. He didn’t want her to “pull the plug” for at least 6 months! His wife laughed and said, “wow, if we didn’t have this discussion I would’ve given you 2 weeks!”. They made light of a very serious situation …but this interaction highlights how people’s views, even those that we are closest to, may be quite different from what we expect.
I was treating another patient who suffered from multiple strokes. She was essentially bedbound with a feeding tube when I had my discussion about “code status” with her. We had a long talk about what she considers a “good quality of life”. And she looked me in the eye and said…as long as I have my vision and can see the sunset, I will be happy and I would want you and any doctor to do whatever it takes to keep me alive.
A sunset for one patient, ice cream for another and just hearing a loved one’s voice for yet another. Everyone has different things that they value; different things that they would want to continue living for. Do you know how you would define “ good quality of life”? Once you figure it out, it is very important to share that with whomever you have designated as your power of attorney.
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