End of Life Issues

Sun and Wispy Clouds Over MountainsIt is the right of every individual to choose and define how they wish to be treated if they are faced with a terminal or life threatening illness and are incapacitated and unable to make the decisions needed to provide care and relief of discomfort. It is best to make these decisions while alive, healthy and mentally competent. The State of Florida has created the Florida Living Will which directs how you wish to be cared for if you develop a terminal illness and end stage condition or enter into a vegetative state and are unable to convey the answers about your care yourself. It is a nonspecific document requiring your signature and the signature of two witnesses. I address these issues with my patients frequently. The living will should be reviewed and signed and given to your physicians, lawyers and a copy kept at home. I usually advise patients to be more specific than the document requires. Do you wish to have a feeding tube placed and be fed artificially if you stop orally taking food and liquids due to a life ending illness? Do you wish to be resuscitated if your heart stops or you spontaneously stop breathing. There is a particular form called a Do Not Resuscitate or DNR form that should be signed and prominently displayed on your refrigerator if you do not want caregivers or first responders to perform CPR on you. A copy can be kept in your wallet and your physician and attorney should have a copy.

You should appoint a health care surrogate to make decisions about your care if you are unable to. This should be someone who knows you and has discussed with you how you wish to be treated in these situations. There is a form to designate a surrogate and it too must be signed and witnessed by two people. It is best to have one surrogate and one alternate. Appointing all your children surrogates just leads to confusion and conflict by committee when a decision that you have already made needs to be instituted.

As a patient you have the right to change your mind at any time either verbally or in writing. It is not unusual for patients to change their mind when they develop an acute medical illness which complicates their chronic life threatening issues which led to executing these documents. Make your choices for yourself. Your doctor and attorney should be able to direct you to the appropriate documents and discuss these issues in greater detail with you.