This legal document states how you want to be treated if you become very ill and there is no reasonable hope for recovery. Without it, physicians are required to act in the ‘best interest’ of the patient.
By: Dr. Richard W. Meyer
While it is not unusual to put off making life-and-death decisions, such issues are critically important ones that every adult should consider, come to a decision about and communicate to loved ones.
In 1990, the Patient Self-Determination Act became federal law. The law requires that health-care facilities ask patients upon admission what their wishes are regarding life-support measures.
Though well-intentioned and quite an important step regarding patients’ rights, this act cannot serve those who are admitted in an incapacitated state and are incapable of autonomous decision-making. Without this knowledge, the physician’s next ethical and legal step is to see if a proxy is available, and if so, what he or she believes would be the patient’s choice. This is called "substituted judgment."
Interestingly, studies have demonstrated that family members and physicians rarely know what a patient truly feels, resulting in answers almost statistically equal to chance. If no proxy is available and the patient is incapacitated, physicians are required to then act in the "best interest" of the patient.
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‘To avoid having your family face dilemmas at an already stressful time, empower them and yourself through communication.’ Dr. Richard W. Meyer
Specialist, Geriatric Medicine The Medical Center at Princeton |
There is a simple task you can perform that can safely and legally take all the guesswork out of this situation. Obtain a copy of an advance medical directive from any medical center, physician, or on-line at www.uslivingwillregistry.com.
An advance medical directive is a legal document in which you state how you want to be treated if you become very ill and there is no reasonable hope for your recovery. Although laws vary from state to state, there are two basic kinds of advance directives:
A living will a legal document in which you state the kind of health care you want or don’t want under certain circumstances.
A health-care proxy a legal document in which you name someone close to you to make decisions about your health care if you become incapacitated.
Most patients find it best to make decisions about their health care after talking with their physicians about the advantages and disadvantages of various treatment options.
Remember: the right of a competent individual to accept or refuse medical treatment is a fundamental right protected by law. Read the advance medical directive, discuss it, fill it out, save it in a safe location and let your family know about it. If you do not have a copy of the living will form, you can write out your wishes and have two witnesses sign and date the paper.
To help you understand just how important this is, consider the following ethical scenarios that may arise during a hospital stay, both for patients with advance medical directives and for those who do not have them. Examples might be:
"My mother has had a stroke and the doctor has told us there is little hope that she will recover. She does not have a living will, but we, her children, know that she valued her independence and would not want to live out her years dependent on others. She is unable to speak or swallow. Should we consent to having a tube inserted so she can be artificially fed?"
"My husband had a heart attack and had to be placed on a ventilator when he arrived at the hospital. He has a living will which states he should not be kept alive ‘on machines.’ Should I ask to have him taken off the ventilator? If so, when?"
"My brother wants my mother kept alive ‘by any means.’ She has a living will which says she would not want ‘heroic measures’ if there were no hope for her recovery. The doctor says there is little hope, and that the pain from her illness is increasing. I want to support my mother’s wishes and ask that a ‘No Code’ (no heroic measures) order be written, but my brother disagrees."
Many ethical issues such as these can be resolved by discussing them with the physician and nurses who are caring for you and your family. To avoid having your family face these dilemmas at an already stressful time, empower them and yourself through communication.
Physicians, health-care facilities and the government care very much about preserving patients’ rights. You can find out more about New Jersey’s laws by contacting the Mercer County Office on Aging at 1-877-222-3737. To prepare an advance medical directive online, go to the U.S. Living Will Registry, a free service offered to the general public.
Dr. Richard W. Meyer is a board-certified internist specializing in geriatric medicine. Dr. Meyer is on staff at The Medical Center at Princeton. This article was prepared in collaboration with Lorraine Seabrook. Health Matters appears Fridays in the Lifestyle section of The Princeton Packet and is contributed by The Medical Center at Princeton.