For the past month, a very close relative of mine was in ICU (Intensive Care Unit) due to a critical illness. But only last week that we were called by her doctors to make a very important decision as a family.
The question is:
Do we still want to continue medical intervention despite futile attempts by the entire medical team?
How far do we still want to go?
As a doctor, I have seen this happen with my patients. I never thought I will be the one to be asked this very hard decision. Being the only doctor in the family, I am tasked to tell them or interpret to them what the doctors have been trying to tell us.
This reminds me of this very important piece of information that is often unheard of or neglected. The living will, this directive in a piece of paper could be the family’s saving grace when faced with this kind of heartbreaking decision.
Let me tell you what it is.
Health-care directives (living will)
This is a living document that allows a person to state whether he or she wants his or her life artificially prolonged under certain conditions.
The Health-Care Directive would only be followed if the patient is diagnosed in writing by the attending physician to be in a terminal condition or in a permanent unconscious situation by two doctors, and where the application of life-sustaining treatments would serve only to artificially prolong the process of dying.
(Source: Philippine Council for Health Research and Development)
Cardiopulmonary resuscitation (CPR) and Do Not Resuscitate (DNR)
A sudden stopping of the heart can cause unexpected death. But it can also be the natural end and painless release from a chronic, painful illness. CPR is a series of measures performed to prevent death when a sudden collapse occurs because the heart stops.
CPR has the greatest chance of being completely successful when the heart stops suddenly in an otherwise healthy person. When CPR is attempted in elderly patients or those who have many medical problems, it is less likely to be effective. CPR success rates vary depending on your medical condition and should be discussed with your doctor.
In general, success rates are much lower for people who are sick enough to be in the hospital. It is the policy of hospitals to perform CPR on all patients whose heart stops suddenly unless a doctor writes an order not to resuscitate (DNR).
Do Not Resuscitate (DNR) means you don’t want CPR to be done to you in case your heart stops beating.
How to make a Living Will? This involved 3 steps.
Step 1: Ask yourself these questions:
- If terminally ill or permanently unconscious, would you wish to have your heart restarted if it stops? Do you wish that the CPR will be performed to you?
- How much medical treatment do you wish to have if you develop a terminal condition or are permanently unconscious?
- Who should make decisions for you if you are not able to express your wishes?
Before deciding on what you want, consider the quality of life during and after recovery from an illness. This is often an important issue because some people may wish they are dead than alive but their quality of life is already compromised.
Do you still want to be “alive” but “totally and permanently disable?”
Consider quality-of-life issues in making decisions about accepting, rejecting, or stopping medical treatment.
Your doctor and the hospital would like to respect your wishes. But first, they need to know what your wishes are.
These Advance Directives (Living Will) are written, legally-recognized documents that state your choices about health-care treatment or name someone to make such choices for you if you are not able to do so. And as a patient, you have the option to review and revise your advance directives, as needed.
Step 2: Make a Living Will
SEE SAMPLE OF LIVING WILL BELOW:
Sample of Living Will:
Directive made this day ___________________(month, year).
I,__________________________ (name), having the capacity to make health-care decisions, willfully and voluntarily make known my desire that my dying shall not be artificially prolonged under the circumstances set forth below, and do hereby declare that:
(a) If at any time I should be diagnosed in writing to be in terminal condition by the attending doctor, or in a permanent unconscious state by two doctors, and where the application for life-sustaining treatment would serve only to artificially prolong the process of my dying, I direct that such treatment be withheld or withdrawn, and that I be permitted to die naturally. I understand by using this form that terminal condition means incurable and irreversible condition caused by injury, disease, or illness that would within reasonable medical judgment cause death within a reasonable period of time in accordance with accepted medical standards, and where the application of life-sustaining treatment would serve only to prolong the process of dying. I further understand in using this form that a permanent unconscious condition means an incurable and irreversible condition in which I am medically assessed within reasonable medical judgment as having no reasonable probability of recovery from an irreversible coma or permanent vegetative state.
(b) In the absence of my ability to give directions about the use of a life-sustaining treatment, it is my intention that this directive shall be honored by my family and doctor(s) as the final expression of my legal right to refuse medical or surgical treatment and I accept the consequences of such refusal. If another person is appointed to make these decisions for me, I request that the person be guided by this directive and any other clear expressions of my desires.
(c) If I am diagnosed to be in a terminal condition or in a permanent unconscious condition (check one):
- I DO want to have artificially provided nutrition and hydration.
- I DO NOT want to have artificially provided nutrition and hydration.
(d) If I have been diagnosed as pregnant and that diagnosis is known to my doctor, this directive shall have no force or effect during the course of my pregnancy.
(e) I understand the full import of this directive and I am emotionally and mentally capable to make the health-care decisions contained in this directive.
(f) I understand that before I sign this directive, I can add to or delete from or otherwise change the wording of this directive and that I may add or delete from this directive at any time and that changes shall be consistent with Philippine laws to be legally valid.
(g) It is my wish that every part of this directive be fully implemented. If for any reason any part is held invalid, it is my wish that the remainder of my directive be implemented.
Residence Address …………………..……….
The declarer has been personally known to me and I believe him or her to be capable of making health-care decisions.
Step 3: Have it notarized and signed by witnesses.
- The witnesses should not be related by blood or marriage.
- The witnesses would not be entitled to any portion of the estate of the declarer upon death.
- The witnesses shall not be the attending physician or an employee of the attending physician or a health facility in which the declarer is a patient.
- The directive shall be notarized.
- The directive or copy thereof shall be made part of patient’s medical records retained by the attending physician.
The advantages of Creating a Living Will:
- By creating a “living will” or “Advance Health Directives” you are saving your family from facing the hard and heart breaking decision by making the decision YOURS.
- It can also prevent arguments among family members with different opinions.
- You can refuse treatments you don’t want by letting them know what you want.
- Another important thing to consider here is, you can lessen the financial load of prolonged and expensive treatments, by letting your family know, how far do want them to go.
As a person who recently experienced being asked “how far will you go to save your loved one”, it is a never easy answer to make. I always questioned myself if we have decided the “best” or should we have fought a little longer? Will it make a difference? I don’t know, the doctor in me says, “I don’t want her to suffer anymore since I know how little the chances are, I don’t want to see her like that situation anymore. And maybe, just maybe that’s what she wanted too.”
Whatever the family’s decision with living will or not will always be painful. But what happened made me realized that, LIFE is not ours to take, it’s never a decision to make, it is the LIFE we are made to lived.
And in the end, it’s not the years in your life that count.
It’s the LIFE in your YEARS.
To my Yayay, You have a LIFE well lived. You have been the second mom for all of us. We have felt your love – full and warm. We will forever love you. You will always be our one and only Yayay. We love you so much. Until we meet again.
For your Financial Health,
- The Cost of Dying in the Philippines
- Part 1: What is Estate Tax and How it can hurt you even After Death?
- Giving your Wealth too soon? How can it affect you?
- How much life insurance do you EXACTLY need? Here’s how to compute
Need a guide to financial wellness? Contact Dr. Pinky here.
Philippine Council for Health Research and Development
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