Got advanced directives?

Making sure those who need to know have your thoughts on how far to take modern medicine is essential, said Michell Erisman, RN, BSN and hospice liaison at Ennis-based Family First Hospice.

Only 25 percent of Americans have advanced directives, Erisman said.

“There are forms that are fairly easy to fill out that can save decisions that  otherwise might have to be made during a difficult time when people are grieving and the burden might be on caregivers to make decisions,” she said.

It’s become more of an issue because of the way people are living and dying, she said.

A hundred years ago, the median life expectancy was around 40 years of age.

That figure is almost double now, thanks to modern medicine, said Erisman, who explained the differences in the two eras.

“(100 years ago) people were healthy up until then, because what would generally take their life would be an acute illness. Now the median lifespan age is close to 80, so it’s almost doubled,” Erisman said.

“When you look at someone's end-of-life journey, usually you’re faced with a long period of chronic illness. We’ve progressed and advanced with medical treatments and antibiotics, so now we're facing more chronic illness, and that’s what’s taking our life. Most of us, during our end of life, will be under the care of health care professionals, whether it’s in a hospital setting, a nursing home setting, assisted living, home health care or hospice,” she said.

An upcoming workshop set for Feb. 26 at Ennis Regional Medical Center will provide information to the public, Erisman said.

“It’s important for our health care professionals to know what one’s wishes are during the end of life.”

The workshop will provide simple instructions for getting advanced directives in place. There are three basic kinds of directives to be addressed next week, said Erisman.

Advanced directives to physicians, durable power of attorney for health care and out-of-hospital Do Not Resuscitate (DNR).

Erisman said she has her own directives in place.

“I would want hospice care if I was terminal. I would want to be comfortable, I would not want CPR or intubation. I’ve discussed this with my family and my doctor has it at the doctor’s office,” she said.

She has also discussed her parents’ wishes for themselves.

Her mother has emphysema, and doesn’t want any life-prolonging measures.

“She just wants to be comfortable, and she was afraid my father would want everything done for her, so she asked me to be her power of attorney,” Erisman said.

“I’ve heard someone say it’s one of the last gifts you can give your loved ones, to relieve them of having to make decisions while they’re grieving,” she said.

And to a woman who protested at carrying what she perceived as a huge responsibility, Erisman had this to say.

“Think of it as you are the voice for what your mom would have wanted,” she said.

One of the most difficult decisions can be whether or not to place a feeding tube in a patient. Traditionally, intervention has been viewed as love in action. Love means always having to do something, to keep the beloved on hand, without regard to their suffering and the patient’s own wishes.

For family members who aren’t trained in medical terms, making decisions can be difficult. That’s where information provided to the dying patient’s care team in the form of the advanced directive comes in, Erisman said.

“It’s important to come together as a team, so they can hear it from different avenues so they can understand the full picture,” she said.

Sherrie Watkins, RN, MSN, is chief clinical officer at Ennis Regional Medical Center.

One of the best reasons to make plans and make them known is that without written instructions, what you want might not be what you’re going to get, Watkins said.

“People don’t realize how complicated the legal system is these days,” she said. “Your wishes could become so lost, if you don’t write them down.”

From the hospital’s point of view, the patient’s wishes need to be known and then carried out, she said.

“How we make sure of this is through an advanced directive, so we can be sure the wishes of the patient are really carried out,” Watkins said.

Continuing education on advanced directives is an important part of the hospital’s staff training, she said.

One classic scenario where advanced directives would be helpful can include a patient who ends up on a ventilator, from respiratory failure, stroke, or overwhelming infection insult.

“If the machine is mechanically keeping them alive, that’s when it gets confusing for families,” she said..

If there’s no more hope, there's brain death or no ability to sustain life – if efforts are futile and the outcome isn’t going to change, if there’s an irreversible condition. Those are the times an advanced directive makes a difference, Watkins said.

In the event that there is no advanced directive on file in the case of a dying patient, such as in the world-famous case of Terry Schiavo, the hospital’s ethics committee examines the case. The group of physicians then works with the patient’s family in an effort to understand what the patient’s wishes would be.

Within a patient’s system, the overlapping circles of cultural and religious views of the patient, his family, physician, health care agency and hospice team may have differing views based on cultural or religious values, so getting on the same team is essential, Watkins said.

“The very best thing is to have those advanced directives. They give clarity at the end of the day about what the patient would want,” she said.

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