Monday, November 15, 2010

Advance Care Directives

Know who you are and what you want. This is important, especially in an emergency. My spouse knows my wishes. While there is no reason to be in pain for many death-related medical issues, there are extreme mesure we should not be given, e.g., CPR in the case of palliative care.


Futile Care and CPR

5 May 2009 ... RRT documentation as referral to palliative care · Volunteers for PC Patients.

 Advance care directives ensure that your wishes are met. Doctors need counselling on how to talk to clients. Trick is to have emergency staff accepting these directives.
This is an excellent article:

Understanding CPR and DNR  (This section has been reviewed and approved by the Cancer.Net Editorial Board, 5/05)

As you make your decision, consider the following points:

  • Do you have strong personal, religious, or spiritual views about dying and care at the end of life?
  • Would CPR likely enable you to return to a quality of life and level of activity that would be acceptable to you?
  • Are there important tasks that feel unfinished? Do you need to say things to loved ones or complete financial tasks that will allow them to live better after you die?
  • If CPR were partially successful, would you want to be placed on a ventilator?
  • Do you have strong feelings about dying at home versus in a hospital setting? (CPR may increase the likelihood of dying in a hospital setting)

Physicians are good with euphemisms.  Know your rights and demand the truth. Be prepared.
Understand what end-of-life care looks like, what it means, and your options.

2 comments:

1 said...

But what assurance do we have they will listen to us, our caregivers, or follow a directive? There are many examples of nursing homes, for example, ignoring the patient and family wishes.

See GO PUBLIC. See White Coat Black Art program March 29.

If I indicate No. 1 on your slide chart, does that mean I will not be given antibiotics if I have pneumonia (from which I would have a good chance of recovering)? If a person has a "do not recusitate" order does that mean she will not be given pain medication? Or even food, water?

See: Elder Advocates of Alberta Society, for many examples this being but one:
http://elderadvocates.ca/advanced-care-plan/

Jenn Jilks said...

There are medical standards, and think of it like an inverted pyramid. DNR doesn't mean you don't treat symptoms, but it does mean the fragile 90-yr olds don't have their ribs broken when being given resuscitation in an ER, when they are dying.

Pain medication is something misunderstood by many. Yes, you are given pain meds.
For those who are palliative, many are not hungry, and are unable to digest food.

You have assurance by having conversations about this. You don't know what will happen, you can only let your loved ones who your wishes. Putting it in writing isn't always a guarantee, as some LTC and retirement homes ignore them, but it is a start.

There is a difference between a plan and a Advanced Care Directive, that you have signed.

It is nothing to do with doctors. It is something all Primary Healthcare teams must be aware of and follow. It is often stuck to the frige, for my hospice clients. They are given very specific questions to determine their wishes when they become a client.

I've listened to the WCBA , too. You must keep in mind that variations exist between provinces.