Be Careful What You Ask For

Be Careful What You Ask For

Healthcare directives require careful consideration.

A couple of years ago, I read the story of a 50-something woman who was recovering from knee surgery at a rehab center. She had completed her healthcare directive, which the center had on file. The Do Not Resuscitate box had been checked.

Then, tragedy struck.

A nurse mistakenly administered a medication overdose, causing the woman’s heart to stop. Honoring the DNR checked box, the medical team did not perform CPR or intubate. The patient could have survived…she would have survived and fully recovered. Instead, the woman’s shocked family received the devastating news of her death.

Healthcare directives require careful wording.

Avoid simple checkboxes in your healthcare directives.
Healthcare directives are vital to articulate your wishes for future healthcare decisions. An effective healthcare directive—which requires more than merely checked boxes—will support your loved ones and healthcare agents who might be faced with making difficult choices on your behalf. Every adult has the opportunity—and the responsibility—to express end-of-life preferences through a directive.

Because the topic is uncomfortable, many individuals rush through completing a form to just “get it done.” Casual remarks are shared in conversation, without the counterbalance of probing, clarifying questions.

Guilt and confusion often plague families coping with a loved one’s final wishes. As you articulate your preferences for future and end-of-life care, consider crafting language that leaves room for loved ones to navigate through unanticipated circumstances.

Beware of black-and-white statements such as: “I do not want ….”

Whether the sentence finishes with resuscitation, intubation, antibiotics or artificial food/hydration, categorically denying care can present difficulties for healthcare agents striving to follow your instructions, yet serve your best interest.

Imagine a circumstance where a feeding tube, if administered, would allow your body to gain the strength necessary to recover. Perhaps a stroke has altered your ability to swallow. Yet with the temporary support of artificial nutrition through a feeding tube and subsequent physical therapy, a full recovery is possible.

A healthcare directive that states: “Under no circumstances do I want to receive artificial food or hydration” could rob you of years of life. Checked boxes, without supporting context, can similarly restrain your healthcare agent’s ability to make choices that best serve your interests.

Instead, consider offering language with a broader context. For example:

  • If I am actively dying, I do not want to receive treatments that attempt to prolong my life. I accept death as part of life and I am not afraid to die. Please provide palliative care to keep me as comfortable as possible.
  • If a treatment or medication has not been helping me to improve after a medically reasonable period of time (which my doctors can evaluate), I want that treatment to be withheld or withdrawn. I give my permission and I ask that my healthcare agents and loved ones do not harbor any guilt or remorse for this decision.
  • I do not wish to receive long-term invasive treatments, such as intubation or artificial food or hydration. However, I understand that such treatments might be necessary for a short time to allow my body to recover, if my medical team believes I have a strong chance of recovery. I define short time in terms of XX days. If I am not improving after XX days, I want that treatment to be withheld or withdrawn. I give my permission and I ask that my healthcare agents and loved ones do not harbor any guilt or remorse for this decision.

These are merely a few suggestions. Writing treatment guidelines that offer principles and direction rather than black-and-white absolutes will better serve your interests. Context is important. So, too, are permission statements to ease the angst of your healthcare agents and loved ones.

Please resist the temptation to merely check boxes to complete a healthcare directive form. Your life may depend on it.

Perhaps you completed a directive years ago, and its content is a vague memory. Now (how about this week?) would be an excellent time to revisit and revise your healthcare directive.

If medical decisions are ever required on your behalf, thoughtfully written guidelines provide the greatest assurance that you will receive the care you desire. And importantly, your loved ones and decision-makers will experience less turmoil, guilt or remorse if faced with difficult choices through unanticipated circumstances.

QUESTION: If you have experienced the frustration of making healthcare decisions for a loved one based on checked boxes, would you please share your story and inspire others via social media? Please share this post with your comment.

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