It is no secret that doctors are prone to providing highly intense medical care right up until a patient’s last breath. The past decades have seen large advances in biomedicine that have greatly improved our ability to extend people’s lives. Ongoing research in biomedicine and advance care planning continues to inform current practices and debates, ensuring that recommendations are based on the latest scientific evidence. The popular dilemma surrounding this issue asks whether the few extra months or years that patients receive are worth the costs involved.
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The Two Sides of the Issue
Every day doctors witness families wrestling with the decision-making process of what to do when their sick loved ones become terminally ill. Surprisingly, about 70% of Americans never sign an advance directive. If there is no advance directive in place that directs the patient’s wishes when they become too sick to speak for themselves, then families are often at a loss as to how to proceed.
On the one hand, family members may struggle with decision-making because it can be very hard to accept losing a loved one, and there is usually at least a small chance that the illness will go away if enough money is thrown at it. On the other hand, sick patients often suffer significant pain and discomfort while on life support. They are usually the first to accept that their lives are coming to an end and do not want their family to go broke just to give them a little more time.
No Easy Answer
Combining all this with the emotional pain involved, there is really no easy answer, but looking at what doctors choose for themselves might shed some light on how to get through this scenario as relatively unscathed as possible.
So What Do Doctors Do?
A 2013 study conducted at the Stanford Hospital & Clinics and the Veterans Affairs Palo Alto Health Care System found that nearly 90% of doctors opt for a “do-not-resuscitate” or “allow natural death” order for themselves. This means that doctors do not want to receive CPR if their heart stops beating. Furthermore, over 80% of doctors do not wish to receive any intense medical intervention to delay death when they become terminally ill.
Part of the problem is that doctors do not have an incentive to explain to the patient’s family the true chances of the patient returning to the person they once were or living any semblance of a normal life again. The medical system is currently geared on a kind of healthcare “upselling,” emphasizing the best possible treatment available regardless of the financial or emotional cost involved. What this means for us is that it is vital to make our own decisions and wishes known to our families before we become sick and it is too late, including communicating healthcare decisions clearly. Talking with loved ones and healthcare providers about your preferences ensures that your wishes are understood and respected. It is important to talk openly and honestly about your values and choices as part of the advance care planning process.
The Role of a Healthcare Proxy
When it comes to making your own healthcare decisions, especially in situations where you might be unable to speak for yourself, appointing a healthcare proxy is one of the most important steps you can take in your advance care planning. A healthcare proxy (sometimes called a healthcare agent or representative) is a trusted friend or family member you legally designate to make medical decisions on your behalf if you become incapacitated due to a serious illness, accident, or mental health crisis.
This role is established through an advance directive, a legal document that spells out your treatment preferences for medical care, including end-of-life care and life-sustaining treatment. Your healthcare proxy acts as your voice, ensuring that your wishes regarding specific treatments such as cardiopulmonary resuscitation (CPR), tube feeding, or palliative care are communicated clearly to doctors, nurses, and other healthcare providers.
Choosing the right person as your healthcare proxy is crucial. Ideally, this should be someone who understands your values, beliefs, and priorities about medical treatment, and who is willing to advocate for your wishes, even if those wishes are not explicitly detailed in your living will or other legal documents. Many people select a close family member, but you can also choose a trusted friend or another individual who is comfortable making difficult healthcare decisions under pressure.
How to Create Advance Directives
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