By: Dr. Bruce Snyder; Vascular Surgeon, Greenville Health System; president, South Carolina Medical Association
April 16, 2014 will be the seventh annual National Healthcare Decisions Day. Each year this day serves as a reminder of the need for us to ensure that all South Carolinians with decision-making capacity fulfill their opportunity to understand, document, and share their choices of future healthcare decisions. What healthcare choices are the right choices for you and your family? Who will speak for you if you are unable to speak for yourself?
As a Vascular Surgeon, I unfortunately often care for patients who experience an unexpected catastrophic event such as a ruptured Aortic Aneurysm or major stroke. Frequently the patient’s family is confronted with the dilemma of how much care they think their loved one would wish to be provided in such a situation. It is difficult to expect anyone in such a stressful time to be comfortable making such serious decisions for their loved one if previously there have not been serious discussions about healthcare choices.
Many of us may have considered what care we would provide our pet with a serious or terminal illness, but have we thought about what care we would like to be provided for ourselves? Each of us has the ability through Advance Directives to document the extent and types of care we wish to have provided. Likewise we can indicate what care we do not want to receive. It is important that we as individuals make these decisions and appropriately document and share them. How many of us have had a loved one become seriously ill or suffer a sudden accident without us understanding what he or she wished for their future care? Have you sat in a hospital room or Intensive Care waiting area uncertain what a loved one would wish done? Would he or she want medical interventions such as being placed on a ventilator, having dialysis, a feeding tube, or the chest compressions and electric shocks of CPR? We can often avoid that unexpected situation for our spouse, partner, or children by completing simple, easy to understand Advance Directives now while we are healthy and capable of making our own decisions. It is also important to designate who we wish to make decisions for us if unexpected situations arise through a South Carolina Health Care Power of Attorney. We can choose as our agent a family member or friend. The choice is ours when we plan in advance.
There is no one-size-fits-all or single correct decision in healthcare choices. I understand that as our lives change our desires for the healthcare level provided and its limits will also change. The healthy 50 year old may or may not make the same choices that he or she would make at age 70 or 80 with multiple chronic illnesses. I may not make the same choice that you select. My choice for me may not be the best choice for you, and therefore you, your family, and your physicians should understand the healthcare you desire.
My siblings and I were pleased that both of our parents completed Advance Directives with the advice of their personal physicians. Twenty years ago my mother chose to not be placed on a ventilator again because of her day to day struggles due to severe emphysema. Likewise a little over two years ago my father died without aggressive intervention or CPR. Neither gave up the good fight, but both understood their need to make the decision that was most appropriate for them. My mother was confined to the home, required a walker, slept poorly, and was constantly short of breath even with oxygen. Two years earlier she spent five days on a ventilator and after recovery from her acute illness was able to return to her home, but saw her health steadily deteriorate and therefore eventually chose supportive comfort care. My father at age 85 started dialysis and for over two years was able to drive himself back and forth for treatments three days a week, eat out with multiple lady friends, and remain active in his church. Then as his health deteriorated, he required van transportation for his dialysis treatments, required an electric scooter, and had shortness of breath with minimal activity. He discussed his options with his physicians, children, and friends; and then he also decided not to undergo more extensive care. I had served as his health care agent with his wish for me to make healthcare decisions if he could not make them for himself. Having completed both his Advance Directive and Health Care Power of Attorney gave him, my siblings, and me, assurance that his wishes would be followed.
The South Carolina Medical Association, South Carolina Hospital Association, South Carolina Bar Association, and the Carolinas Center for Hospice and End of Life Care have jointly developed documents to assist with your healthcare planning available at http://www.scha.org/shared-decision-making. Please visit this site with your family to begin planning for your healthcare future. Download and complete your Advance Directives. Share your wishes with those who care about you; your family, friends, and physicians. Do this for yourself and your loved ones.
