[Rhodes22-list] Not About Sailing - About Advance Directives!

[William P. Barry, III]

I understand how the Terry Shiavo case has people thining about and planning
ahead for advanced directives. I agree that they are something that should
be discussed and written out should something happen, however I also would
like to point out that just because something is written as to what you
would like to happen, it does not necessarily mean it will. As an emergency
healthcare providor i have been in almost a half dozen situations over the
past year that I have had to make strong moral and legal decisions over with
no time to think about it. These were primarilly in cases of DNR orders for
CPR needed. In the state of New Jersey if i were to come into a scene of an
unresponsive person and CPR was needed I am required by law to provide full
care. The ONLY case in which I can legally honor advanced directives are if
the ORIGINAL DNR is physically presented to me and in my hands. It must be
less than 1 year old to date, signed by the person themselves, a witness,
and a doctor, and notarized. If any or one of this criteria is not met the
family has the right to sue and more than likely legally win. I understand
that in the situation of a 94 year old that drifted away in the middle of
the night from a long term illness and suffering with no mental awareness
that it would be morally wrong in my opinion to go through the entire
process of trying to revive them. However this is a distinct example in
which from the legal point of view i had to honor the state laws and do
everything in my power to revive them. This includes going against the
wishes of the present family members. There was a DNR present, however it
was 4 years old and unable to be renewed do to the fact that the patient was
no longer mentally able to make her own legal decisions. Myself and my crew
ultimately had to make the decision whether to go against state guidelines
and possibly having the ability to open ourselves up for a lawsuit, or do
what we believed to be morally right and let nature take its course. We
eventually ended up following state protocol, continuing CPR and ultimately
reviving the patient. This was one CPR save that i am not sure was one
deserving of award and credit. As a crew our decision was based on the fact
that if the family decided anywhere between the time of the incident and 7
years from that point on, that the loss of their mother was due to our
decision not to initiate full revival efforts, the state law would come
first in the decision that we were wrong.

Will Barry


----- Original Message -----
From: "Nell" <nellwolfe at cox.net>
To: "'The Rhodes 22 mail list'" <rhodes22-list at rhodes22.org>
Sent: Tuesday, March 29, 2005 3:22 PM
Subject: RE: [Rhodes22-list] Not About Sailing - About Advance Directives!


> Slim,
>
> Thank you for your response to my posting.
> If Terri Schiavo accomplishes one thing in her life, I hope it is to raise
> awareness and call to action every adult to put into place written advance
> directives. Sometimes, our ultimate accomplishment in life is in dying.
> Perhaps she will help many of us to die with the dignity that we all
> deserve.
>
> To address your questions:
> Each state has different requirements when it comes to making advance
> directives. So it is important to complete a document specific to your
home
> state.
>
> Healthcare Power of Attorney is the preferred advance directive document
> because it indicates who will make decisions and how and what decisions
will
> be made. It allows an adult to designate a person (healthcare agent,
> healthcare proxy, representative) to make end-of-life care decisions for
> them in the event they cannot make their own decisions.
>
> A Living Will often deals with a very narrow set of medical conditions.
> Often the living will states that treatment may be stopped if the person
is
> terminally ill or in a persistent vegetative state. These conditions are
> strictly defined by law. While the adult may think of a condition
described
> as "terminal" as a fatal condition, the law may define it as a condition
> that will cause death soon despite treatment. Although an adult may define
a
> vegetative state as being useless, the law may define it as a condition
> where one is permanently unconscious and the brainstem is intact.
>
> It is possible to have both a Healthcare Power of Attorney and a Living
> Will. But most of us will find that the Healthcare Power of Attorney is
> sufficient. The agent or spokesperson is the Healthcare Power of Attorney.
> The different terms are not meant to confuse but to offer different means
> for understanding.
>
> I am sending as an attachment a Power of Attorney for Healthcare developed
> to meet the legal requirements for Wisconsin, Minnesota, and Iowa. It is
> directly taken from my Facilitators Manual called "Respecting Choices" 2nd
> edition, written by Gunderson Lutheran Programs for Improving End-Of-Life
> Care of Gunderson Lutheran Medical Foundation.
>
> After examining the document, I think you will see where (page 8) you can
> include additional instructions or limitations such as specific
> scenarios/procedures e.g. respirators, dialysis, surgery, etc or you can
> leave it "open-ended". Above all, remember, this is not a static document!
> As your health status changes, as designated agents die, move away, become
> estranged, divorce, etc. you need to re-visit your plan to determine if
you
> wish to make changes. A good time to do this is annually; say when you
have
> your routing physical, when you do your taxes, when you prepare for a
> vacation, etc.
>
> Next time you are having an out patient procedure ask the patient
> representative, the chaplain at the hospital, or even the admissions clerk
> for a Healthcare Power of Attorney form. Look it over, fill it out as if
you
> didn't already have one, then take it home and compare it with the one
> currently in place. If the "current" one doesn't reflect how you want
things
> done now, it's a good time to put the changes into effect.
>
> Hope this helps. Let me know if you have more questions.
>
> Take Care.
> Nell
>
> -----Original Message-----
> From: rhodes22-list-bounces at rhodes22.org
> [mailto:rhodes22-list-bounces at rhodes22.org] On Behalf Of Steve Alm
> Sent: Tuesday, March 29, 2005 9:06 PM
> To: Rhodes
> Subject: Re: [Rhodes22-list] Not About Sailing - About Advance Directives!
>
> Nell,
>
> Thank you.  I know people all over the country, like me, are now
scrambling
> to understand this and prepare the proper documents.  Please explain the
> difference between having a Living Will and a Healthcare Power Of
Attorney.
> Does the former require the latter?  Can the latter suffice by itself?  I
> don't understand the difference between a Power Of Attorney and an "agent"
> or "spokesperson."  This probably varies from state to state.  (I'm in
> Minnesota)  As I understand it, some documents list specific
> scenarios/procedures such as respirators, dialysis, surgery, etc. that are
> to be expedited or not, and under specific situations.  But of course a
> healthy adult cannot predict what may happen, so how do you allow for
> something more "open-ended?"
>
> Slim
>
> On 3/28/05 11:54 AM, "Nell" <nellwolfe at cox.net> wrote:
>
> > For All the Rhodes 22 folks out there,
> >
> > I have written the following article for submission as a freelance
writer.
> >
> > I would appreciate your comments please.
> >
> >
> >
> > I am an Advanced Care Planning Facilitator. It is my job to help
> interested
> > people in understanding the different methods
> > by which they may make their wishes known regarding the extent to which
> they
> > would like to be kept alive in the event that
> > they experience an event which renders them in varying degrees of
> > incapacitation.
> >
> > The first thing the reader should keep in mind is that NO Advanced
> Directive
> > means that family or the courts will ultimately
> > make decisions about you based on what they want for you - not what you
> want
> > for you!
> >
> > The belief that "everybody who knows me knows what I want in the event I
> am
> > no longer able to speak for myself" is the same
> > as leaving it up to family, friends, and the courts. Terri Schiavo is
the
> > object of a bitter struggle between her husband, her parents,
> > and the courts precisely because she left no advanced directives IN
> WRITING!
> > Recollections, reported past conversations, and
> > incidental remarks purportedly made by Ms. Schiavo are all that is
> available
> > to attempt to determine what her wishes might be.
> >
> > Secondly, it does not need to cost a penny to complete an Advanced
> > Directive. Yes, you can formulate a Healthcare Power of
> > Attorney or Living Will through an attorney but you can just as easily
> > complete such a document whenever you or a loved one
> > seeks care at a hospital or medical care facility.
> >
> > While the specific names for the documents and some of the details
> contained
> > within the documents vary according to state,
> > the essence of making the specifics of what you would like to have done
or
> > not done when you can no longer speak for yourself
> > are similar nationwide. The basis for encouraging the formulation of
such
> > directives is a respect for individual well-being and
> > the right to self-determination.
> >
> > In fact, as the result of congressional passage of the Patient Self
> > Determination Act in 1991, all health institutions (hospitals,
> > long term care facilities, hospices, home health agencies) in all 50
> states
> > are required to ask all adults on admission if they have a
> > written advance directive and document their responses. Further, these
> > health institutions must provide written information to
> > adults about their right to refuse medical and/or surgical treatment
under
> > the state statutes and standards and policies of the institution.
> >
> > Thirdly, a person may change their written directive at any time.
> >
> > To begin to think about what it means to "live well" means that each of
us
> > may consider our personal values, goals, religious and
> > cultural beliefs. In this way we can begin to understand what we
envision
> > for ourselves as we live out our lives in the best possible
> > manner. By making specific end-of-life treatment choices, each of us can
> > begin to fashion a plan for "living well".
> >
> > It is important to keep in mind that the types of decisions we make are
> > greatly influenced by our health status. Healthy adults need
> > only to begin to think about what they would like. While considering
their
> > options, it is important to begin to consider who they
> > would like to act as their agent or spokesperson when end-of-life issues
> > arise. Conversation with possible spokespersons is very
> > important so that the agent knows clearly what the person wants and
their
> > feelings about types of interventions.
> >
> > People with incurable, progressive diseases like cancer, congestive
heart
> > failure, kidney failure, chronic obstructive pulmonary disease
> > need to understand the progression of their disease and treatment
> decisions
> > they may likely face in the future. Knowing some of the
> > outcome statistics may help the person better understand the benefits
and
> > burdens of life-sustaining treatments.
> >
> > Patients who are living in long term care facilities or are expected to
> die
> > within 12 months need to begin to consider what they feel
> > would be a "good death". In other words, how do they envision living out
> > their final months and days in the best way possible?
> > It is time to talk about resuscitation - its likely outcome; options for
> > withdrawing life-sustaining treatment if the treatments no longer
> > serve the purpose of facilitating a "good death"; comfort care - what it
> > means to the patient and under what circumstances would they
> > want their symptoms controlled even if that meant that death might be
> > hastened.
> >
> > Most importantly, everyone owes it to themselves and to their loved ones
> to
> > begin to think about advance care planning.
> > Talk to your family, talk to your doctor, talk to your clergy. Ask
> yourself
> > the tough questions, then formulate a plan that reflects
> > what you want for yourself. Take the burden of deciding off your loved
> ones.
> > That is the best legacy of all.
> >
> >
> >
> >
> >
> > __________________________________________________
> > Use Rhodes22-list at rhodes22.org, Help? www.rhodes22.org/list
>
> __________________________________________________
> Use Rhodes22-list at rhodes22.org, Help? www.rhodes22.org/list
>


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