April 14, 2013
LIMA — It breaks all the rules of polite conversation, but it’s a topic that needs to be discussed.
What measures should be taken to keep you alive if you become ill?
“All you have to do is say the name Terri Schiavo,” said Dottie Kaiser, quality resource manager at Lima Memorial Health System. Schiavo, who was in a vegetative state, died in 2005 after a prolonged struggle between her husband and her parents over whether to terminate life support.
Tuesday is National Healthcare Decisions Day, and both Lima Memorial Health System and St. Rita’s Medical Center are holding events. People are welcome to attend to learn more about living wills and naming someone your medical power of attorney. The paperwork is free.
In 1992, a federal law went into place that allowed people to choose what they wanted when it came to end-of-life issues, Kaiser said. Some might want all efforts to be made to keep them alive, even if their brain function is gone, while some might choose not to even allow CPR. At this time in our country, Dr. Jack Kevorkian and his assisted suicides were a hot-button issue — and Ohio’s legislators wrote a very specific, detailed law concerning end of life, Kaiser said. The downside is the paperwork is complicated, and the average person often needs help understanding it.
A living will is a legal document that lists what procedures you would like to be done — or not done — in the event you are terminally ill or permenantly unconscious. (Health problems that are not permenant, like a stroke, do not apply.) This document helps outline your wishes when you cannot speak for yourself.
A medical power of attorney is a person you choose to speak up on your behalf when you cannot to be sure your living will is followed. The key here is the word medical. A lawyer needs to be consulted for paperwork concerning finances.
If these documents are not in place, a bad situation quickly becomes worse.
“Then you’ve got your children having disagreements while you’re lying in bed, critically ill,” Kaiser said. “From a parent’s perspective, you don’t want your children fighting while you’re on your death bed.”
If you’ve been clear about your wishes, it takes the pressure off your family, Kaiser said.
Diana Coppler, palliative care manager at Lima Memorial Health System, agreed.
“As a palliative care manager, I see families and patients all the time involved with sometimes making hard decisions for their loved ones, and it’s so much easier …. by having a living will or durable power of attorney,” Coppler said. “Those papers tell the family what they want. The family’s just going to honor their decision.”
Coppler often hears families say, “they never wanted this,” but those decisions had never been formalized.
Amy Marcum, director of spiritual care at St. Rita’s Medical Center, also noted the state has a legal hierarchy on who can speak for the patient if no power of attorney is completed. The power to make decisions usually first falls to a spouse, then adult children, then parents, then next of kin.
“The legal hierarchy might not be who you want,” Marcum said. “It’s helpful to have a spokesperson.”
Another distinction that is important to make is what the medical community refers to as code status. When a person is admitted to a hospital, staff will ask about code status — how aggressively the staff will work to save a person’s life. This is separate from the choices made in a living will. Coppler explained: “Full code” means every effort will be made, including life support. “DNRCC-A” means every effort will be made until the heart stops or breathing stops. “DNRCC” means the focus shifts to keeping a person comfortable when illness is terminal.
All this is to keep the patient firmly in charge of what is happening.
“Something’s going to happen to all of us at some point in our lives,” Kaiser said. “Talk to your family. Because you don’t want to make the national news.”