There comes a time we all must face death. As a doctor caring for critically ill patients, many in their final months, days, and hours, my goal is to create a comfortable situation for the patient and their loved ones.
It’s not always easy, but I do my best. It is often the best care, the most personally rewarding care, I can give.
Some patients and their families are fully prepared with a living will and a health care power of attorney document that appoints a health care agent.
For example, I remember a family that, for the purposes of this story, I’ll call the Smiths. Mr. Smith started smoking cigarettes when he was in high school. He smoked for nearly 40 years. As he was entering his mid-50s, he was diagnosed with terminal cancer and given months to live. Before being diagnosed, he had taken care of legal matters should something happen to him. This included a living will, in which he named his wife as his health care agent.
Everything was clearly spelled out. In his living will, he decided to limit measures if ever terminal to only those that would keep him comfortable and relieve pain. He also made sure that his wife, acting as his health care agent, knew this, and his family was aware of these arrangements as well.
As Mr. Smith’s condition advanced, hospice was involved to help him and his family. Mr. Smith’s final days were peaceful. The family gathered to be with him. He passed quietly in the comfort of his home, with his loving family beside him.
His example is in contrast to a similar patient that for the purpose of this story, I’ll call Mr. Jones.
Mr. Jones was a hard-working retired steel worker. Before his retirement, he showed up every day to work on time, put in extra hours when possible to increase his income, and was liked by his neighbors. His four grown children had moved out of the area to advance their careers after college. His wife of nearly 50 years passed away a few years before him.
One snowy Pittsburgh day, Mr. Jones contracted a severe pneumonia. He lingered for days as his children and close friends gathered by his bedside. Mr. Jones wasn’t prepared for this sudden event. He had no living will, nor had he made arrangements for a health care agent.
As his doctor, I sat down with his family to discuss options. There was disagreement in the room between his children. Close friends also voiced their thoughts. Bitter words were spoken.
Eventually, after a few more days, Mr. Jones died. But, the anger between his children and friends didn’t. This situation likely could have been avoided if Mr. Jones had a living will or had appointed a health care agent … even just discussed his wishes with some family members.
Most recently, the Pennsylvania legislature passed a new law that clarifies end-of-life-care decision-making. On Nov. 30, 2006, former Gov. Edward Rendell signed Act 169 of 2006, that provides for medical treatment decisions to be made for an adult incompetent patient through a living will, health care power of attorney, or both.
In the event that an incompetent patient doesn’t have a living will or a health care power of attorney, the new law provides for health care decisions to be made for the patient by a close family member or other health care representative designated by the patient or authorized by under the law.
Through its Family Health and Wellness program, the Pennsylvania Medical Society is dedicating myfamilywellness.cdmail.biz to this issue to help Pennsylvania patients and caregivers gain a better understanding of living wills, health care agents, and this new law.
As a doctor who has treated thousands of ICU patients during my career, I encourage you to use the Pennsylvania Medical Society’s Family Health and Wellness website to learn more. I also encourage you to have a living will and a health care agent.
Christopher M. Hughes, MD
Critical Care Specialist, Pittsburgh, PA