What Comes With Death in Mind Family and Patient
letters
Tough Decisions Most End-of-Life Intendance
Readers offer personal stories in response to a doctor's guest essay near accelerate directives.
To the Editor:
Re "A Improve Way to Face Death," by Dr. Daniela J. Lamas (Opinion guest essay, January. 6):
Besides often, accelerate directives are construed as immutable guides to how ane dies. We have plant advance directives to be more than helpful if we focus on how i wants to live.
If we ask about ventilators or dialysis or artificial diet, we are typically asking people to express opinions about topics that they do non know well, usually based on preconceived and often inaccurate notions about these medical technologies. It is petty wonder, and so, when really faced with the technology, patients will modify their mind. What was one time unacceptable may at present be tolerable because life even so holds a desired quality. The opposite may occur; handling that was once strongly desired in the abstract may not deliver the quality of life that was hoped for.
Advance directives should accomplish 2 goals: identification of a surrogate — one who tin "stand in the shoes" of the patient, and the identification of preferences — what is of import in how you live.
A focus on evolving ideas rather than document completion will exist more likely to bring the patient'south phonation to decision-making at crucial times.
Margaret M. Mahon
Ann Berger
Bethesda, Physician.
Dr. Berger is chief of the Pain and Palliative Intendance team at the National Institutes of Wellness Clinical Center, and Ms. Mahon is a nurse practitioner with the squad.
To the Editor:
Dr. Daniela Lamas makes a strong case for careful consideration of advanced directives, simply I would also embrace the avant-garde age of the patient as a critical factor for end-of-life decisions.
I was born during the Hoover administration, so for me death is non an abstruse concept. While there is an overabundance of suggestions on how to achieve quondam historic period (many involve kale and Pilates), there is less data on what happens when you get there. In ane's 80s bodies brainstorm to lose one time reliable mechanisms, and there is no ameliorate proof than the aisles of developed diapers in our markets. Foods you once enjoyed penalize you. Mobility issues impose woeful limits. Your address book looks similar a cemetery. Each twenty-four hour period presents small challenges.
The documented horrors of nursing homes, the toll elder care takes on families and the obscene toll of protracted end-of-life nursing all come into play.
Heartfelt conversations with my anile friends assure me that we would all prefer dying in our slumber to lingering a bit longer in discomfort and humiliation.
The anxiety, indignities and malaise of advanced historic period demand acceptance — and a humor. Similar most of my peers, I am not afraid of dying but of beingness kept live.
Terry Martin Hekker
Nyack, N.Y.
To the Editor:
My dad was ane of those people who changed their mind nigh end-of-life intendance. Before getting cancer, he thought that his meridian priority when suffering would exist to get lots of morphine.
When he was actually dying of cancer, he discovered that he hated morphine. Information technology fabricated him extremely constipated, gave him disturbing hallucinations and impaired his power to be nowadays for the many visitors who came to see him in his final illness.
His wellness care proxy came by every day and turned upwards the morphine, and my dad always turned it downward. He said he didn't have that much pain if he lay nevertheless, and he plant that he got more relief from holding hands than from morphine.
Anne Barschall
Tarrytown, N.Y.
To the Editor:
Nigh of us tin't exactly predict what volition happen when facing death. Dr. Daniela J. Lamas discusses cases common to physicians: Patients change their minds about treatment options, sometimes only to please others.
While some patients are grateful that their wishes were overridden and their lives maintained, others resent unwanted treatments that prolonged their lives and suffering.
Patients should talk over accelerate directives with their physicians. Physicians should regularly review accelerate directives with patients to see if patients have changed their minds. New medical conditions and major life events provide reasons to review advance directives, but basically patients take a right to refuse treatments, and physicians should respect patients' accelerate directives and non override them.
Joel Potash
Syracuse, Due north.Y.
The author is former medical director of Hospice of Central New York and emeritus professor at the Centre for Bioethics and Humanities, Upstate Medical University.
To the Editor:
"A Improve Way to Face Decease" raises the problematic issue of either the patient's family or the physicians in accuse ignoring the wishes expressed in a wellness care directive because somehow they believe that the patient did not mean the instructions she legally formalized.
Were I the patient described in this invitee essay, I would be furious that my wishes were not followed. I am 80, have a health condition that could land me in exactly the aforementioned state of affairs described in this piece, and accept been unwavering in my insistence that my wishes never to enter an I.C.U. exist followed. To leave it to others to decipher at whatsoever given moment if I have somehow changed my mind is exactly why a health care directive exists.
My family unit knows that what I have written is what I look. I would want neither my proxy nor the physicians at the bedside to second-guess my wishes.
Susan Meister
Pebble Beach, Calif.
To the Editor:
Dr. Daniela Lamas brought me back to a moment 11 years agone when I was required to decide if information technology was time to end active medical care for a dear friend. He was in his early 80s, and had fallen and suffered a traumatic encephalon injury. His lungs were filling with liquid. His medical directive was: If I am going to die, exercise not take extraordinary measures.
My feel affirmed Dr. Lamas'south vision of meaningful conversations at the fourth dimension of handling if at all possible and in the presence of the medical squad. My friend wasn't witting, and I was getting alien opinions on whether he would die.
My conclusion, which I live comfortably with today, was to bring six close friends of his into his room. We had the conversation in his presence, and agreed that it was fourth dimension to revert to palliative care. He died a few days afterwards. A week later, at that place was a moment when I felt his presence around me, and I understood him to tell me that "everything was OK."
These decisions will be the hardest people will e'er accept to make. In that location is no like shooting fish in a barrel way to practice it and no real training for these moments.
Sam Simon
McLean, Va.
To the Editor:
I am the son and health intendance proxy of a 92-yr-male parent suffering from dementia and early on-stage aspiration. Dr. Daniela Lamas hints at a truth I learn daily on the other side of the equation: While it is heartbreaking for me to meet the father I and then deeply beloved diminished, ofttimes lost and confused, he experiences dear and joy every solar day.
Is his "quality of life" what I would wish for him or what he imagined when hale? No. Nevertheless the moments when he meets someone new and asks them questions, when he feels secure when walking considering I support him, or remembers some odd, obscure detail of some object in his home, evince that his life has quality.
My "chore" is to maximize the positive and manage the negative and pray that I will know when the equation has shifted and so much that it is his time, should I have to make that determination. Information technology hurts beyond hell, but it'south his life and information technology, not mine, is my responsibility here.
Joshua Mack
New York
To the Editor:
Years ago when my female parent was in hospice care with concluding cancer, she asked my father, "Am I dying?" He replied, "Possibly." It was a compassionate answer that was honest, notwithstanding left a door open for unexpected changes. I am forever grateful to him for that loving, elegant and inspired moment of communication in her final days.
Paul Langland
New York
Source: https://www.nytimes.com/2022/01/22/opinion/letters/advance-directives-death.html
0 Response to "What Comes With Death in Mind Family and Patient"
Post a Comment