Critical Decisions
A health care agent is a person chosen in advance to make health care decisions for a person when he/she is no longer able to do so. Sometimes the terms medical power of attorney or health care proxy are used to identity these legal devices that allow one person to indefinitely make medical decisions on behalf of another if that person become ill or incapacitated and can no longer make his own. A type of advanced healthcare directive, they are legal documents. Typically, the person granting the authority retains the power to revoke it.
Often, but not always, the primary caregiver is chosen to be the health care agent. If a loved one has selected you to act on his/her behalf in making these decisions, you need to prepare to adjudicate these serious situations. The most important consideration is learning firsthand from the person who has chosen you – and in most cases this will be a relative – the decisions he/she would make. Realize the two of you may not agree; but your responsibility is to make decision on their behalf, not for them. Make sure these are put in writing (for example, a living will).
Next, familiarize yourself with terms that may come up. Make sure everyone involved in the process (family members should have input) understands words or phrases in the same way.
I still remember the concern I felt in nursing school when some in the class expressed their support for euthanasia for patients whose lives were “burdensome, not worth living, or too costly to prolong.”
The word euthanasia is derived from the Greek eu ‘well’ + thanatos ‘death’ (literally the “good death”). Active euthanasia is the intentional killing of a patient (usually by lethal injection) by the direct intervention of a physician or another party, supposedly because that is what is best for the patient and what he desires. Passive euthanasia is the act or the omission of an act that by intent or consequence results in death. Some have made the distinction between active and passive euthanasia as “killing” and “letting death occur.” Others believe that there is no distinction and either of these choices is iniquitous and that every available medical intervention should be utilized to prolong life. These are grave moral decisions for anyone charged with making them.
Unequivocally, I believe that active euthanasia or physician-assisted suicide (the doctor provides the patient with the means to take his own life) is terribly wrong. However, I also question the practice of extensive life-prolonging medical measures, especially when the patient has a terminal illness, approaching a natural death and the condition cannot be reversed. I will always remember the insightful words of a long-time hospice nurse: “There is a real difference between using life support to prolong life and using it to prolong death.”
As a nurse in long-term care, I realized many family members misunderstood the definition of a Do Not Resuscitate (DNR) order. Often, they thought it meant their loved one would be “left to die” and this is incorrect. Actually, the term is self-explanatory: you cannot resuscitate someone unless his or her breathing or circulation has stopped. In other words, a DNR order means that medical personnel will not attempt to bring someone back to life, not let them die. While cardiopulmonary resuscitation (CPR) can be used effectively in an emergency situation (such as after an accident or sudden cardiac arrest in an otherwise healthy person), patients who are compromised, frail or elderly usually do not respond well and injuries such as broken ribs or collapsed lungs can result.
When a patient is no longer able to swallow or digest food and liquids normally, medically assisted nutrition and hydration are sometimes provided. This is usually through a tube inserted into the stomach – feeding tube, G (gastric) tube, or PEG (percutaneous endoscopic gastrostomy) tube. Nutrition and hydration can also be provided intravenously (IV) or through a tube inserted through the nose – a NG (nasogastric) tube. While these interventions are effectively used for short-term intervention when recovery is possible, sometimes family members request them for a loved one who would otherwise die, believing that refusing to do so would be “starving the patient to death.” When someone is dying, the body “shuts down” and nourishment is no longer needed. Force-feeding can do more harm than good.
I feel as if I have barely touched the surface of this critical subject and may have raised more questions than I have answered. That is why it is so important for health care agents to explore all options with their loved one before the time comes when the decision cannot wait. Discuss in depth. Seek input from medical professionals. Do your own research. Pray for wisdom. In the end the right thing to do is to make the choices your loved one would make.
Caring quote: “Even if one family member is named as the decision-maker, it is a good idea, as much as possible, to have family agreement about the care plan.” – National Institute on Aging