Ryan Hancox, M.D.: Take time to talk to your doctor, decide about medical interventions
Have you made an appointment with your physician to discuss your death?
It may sound morbid, depressing or even a little crazy. But, if you're older than 65 or have chronic medical illness, you should.
If terms like physician orders for life-sustaining treatment, advanced directive and living will sound vaguely familiar, but you are not quite sure what they mean, you should. If you know who you would like to make medical decisions for you when you no longer can, you should make that appointment.
When a heart stops beating or a pair of lungs cease to breathe, a transition to natural death begins. Medical teams in all health-care settings respond by doing everything they can to restore life.
Everything includes CPR, which can fracture multiple ribs. Everything includes intubation, a large plastic tube that goes from the mouth into the trachea and allows a machine to manufacture breaths.
Everything can include ports, IV placement for fluid and medication administration, and nasogastric tubes passed from nose to stomach for nutrition.
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It can include kidney dialysis and urinary catheters.
Unless you have already stated otherwise, all of these measures can be taken. In many cases, these measures are successful in restoring a patient to improved health.
In other cases, particularly when the patient has underlying frailty, advanced age and complicated medical illness, the measures may be unsuccessful. They may even lead to decreased quality of life with unnecessary pain and suffering.
Many patients believe the term "do not resuscitate" means doctors will just let the patient die. But DNR actually means aggressive care will not be performed.
Underlying medical problems, such as hypertension and diabetes, will still be treated.
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Some patients may say, “It is OK to do CPR, but don’t put me on a ventilator.” However, when a code is called, it is all or nothing.
These measures go hand in hand, as typically multiple organ systems go into failure and the patient cannot pick and choose what aggressive measures are done.
It is important to remember that any decisions made can be changed later, and that some decisions can be made now, while others may be postponed.
Patients should strive to make informed decisions by understanding the risks and the benefits of each intervention. Medical providers will support these choices and guide you throughout the process.
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Death is part of life, and something all of us will eventually experience. It is scary.
It is hard to talk about. But letting your health-care provider know your wishes ensures that you will never be subjected to interventions that you do not want done. It also prevents your loved ones from having to make rushed, impossible decisions on your behalf.
Your medical provider is here to help you ensure the healthiest life possible, but he or she is also here to help you ensure that, when it is your time, death is on your own terms.
Ryan Hancox, M.D., is a primary care physician at Saint Vincent Hospital.
This article originally appeared on Erie Times-News: Ryan Hancox, M.D.: When to talk to your doctor about death
