End of life care

End of life care

This is a discussion on End of life care within the Off Topic & Humor Discussion forums, part of the The Back Porch category; This is about as far off topic of Defensive Carry as I think you can get. I started thinking aobut it after noticing a thread ...

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Thread: End of life care

  1. #1
    Senior Member Array DoctorBob's Avatar
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    End of life care

    This is about as far off topic of Defensive Carry as I think you can get. I started thinking aobut it after noticing a thread on a church's issue of safety, etc.

    Does your church/synagogue/mosque initiate discussions about end of life care? I realize this is a very hard sell to anyone under 60 but certainly of urgent interest to those of us over 70. One of my medical school classmates just died at age 59 with ALS after being in a coma for many months. That is not the end I would have chosen for myself.

    I have too often been in a situation of struggling to deal with families who have not spent any real time considering this issue. Mom is dying at home with some incurable disease and as she approaches the edge of the precipice, some one in the family calls 911 and rushes her to the hospital emergency department with lights and sirens going and places her in front of me. I feel duty bound at that time, in the abscence of firm written instructions by the patient, to do all the horrible things we do to try to stave off death for a short while. This usually turns out to be VERY difficult and uncomfortable for the patient and very hard on the family. Sometimes it is national news - like the Terry Schivo case in Florida that even involved President Bush and his brother.

    You really also need to discuss it with your doctor and insure that he/she is on the same page with you. For example:
    Physicians' religious leanings may influence treatment decisions.
    The Los Angeles Times (8/25, Kaplan) "Booster Shots" blog reported that, according to a survey of 3,733 UK physicians detailed in the Journal of Medical Ethics, "the strength of a physician's feelings of faith can influence the types of treatment they offer to their patients." For example, "doctors with 'stronger religious faith' were less likely to talk with patients about treatment options that could shorten their lives, such as prescribing powerful pain medicines," and "less likely to keep patients in continuous deep sedation or to support legislation allowing doctor-assisted euthanasia." On the other hand, those "who described themselves as 'very or extremely non-religious'" were "almost twice as likely as religious doctors to report that they had pursued treatments that had the potential to hasten a patient's death, either intentionally or as a side effect."

    Whatever choice you make, your doctor needs to understand that you are the one in charge of this decision...


    If you are interested in resources for discussion with your family or for information for yourself, you can find some useful info here:

    POLST (physician orders for life sustaining treatment) guidelines can vary by state
    http://www.ohsu.edu/polst/
    POLST form for your doctor
    http://www.wsma.org/files/Downloads/...polst_form.pdf

    5 Wishes is another useful source and allows you to really tailor your own plan
    http://www.agingwithdignity.org/five-wishes.php

    If you are not interested in this topic you must believe that even though we are all mortal, God is going to make an exception in your case. Good luck with that...


  2. #2
    Member Array pistola's Avatar
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    I have known several people who were terminaly ill and killed by high doses of morphine. This is a very common practice.....
    U.S. Army Veteran

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    VIP Member Array automatic slim's Avatar
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    Don't worry, under Obamacare we'll all be goners before we hit 70.
    "First gallant South Carolina nobly made the stand."
    Edge of Darkness

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    Member Array chivvalry's Avatar
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    Quote Originally Posted by automatic slim View Post
    Don't worry, under Obamacare we'll all be goners before we hit 70.
    I really don't think this comment adds any value at all to this particular subject.
    "I pledge allegiance to the Flag of the United States of America, and to the Republic for which it stands, one Nation indivisible, with liberty and justice for all."
    You are not paranoid if They are actually out to get you, however, They probably are not and you probably are.

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    Senior Member Array deafdave3's Avatar
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    Quote Originally Posted by chivvalry View Post
    I really don't think this comment adds any value at all to this particular subject.
    No, it doesn't, but I LOVED his comment!
    A CCW is like a parachute; if you need one, and don't have one, you'll probably never need one again.

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    Distinguished Member Array ErnieNWillis's Avatar
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    Quote Originally Posted by chivvalry View Post
    I really don't think this comment adds any value at all to this particular subject.
    I do.

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    Senior Member Array stevem174's Avatar
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    Good info Doc!
    Too many people don't think about this until it's too late. Also in the past I have seen confusion with the difference between a "living will" and a "do not resuscitate"
    Don't do things you don't want to explain to the Paramedics!

    Stupidity should be painful.

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    VIP Member Array NC Bullseye's Avatar
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    dark humor aside, thanks Bob for the reminder that the term "being prepared" should include forethought on what happens when all other preparations fail.

  9. #9
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    Quote Originally Posted by chivvalry View Post
    I really don't think this comment adds any value at all to this particular subject.
    If thats the case, neither does yours.

    Don't ruin what can be a helpful thread.
    "Just blame Sixto"

  10. #10
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    Just as important as discussing this with your doctor is to appoint someone as your healthcare power of attorney to make decisions for you if you are unable to do so - and make sure that person knows what you want, and has the fortitude to push for it.

    Having spent more than a little time in emergency and critical care settings, I can tell you that there is nothing uglier than a family quarreling over how to handle a family member who cannot make decisions for themselves. And in my experience, most of the time if there is an advance directive that says X and an immediate family member who says Y, the docs will comply with the wishes of the relative who is alive to sue.

    Matt
    Battle Plan (n) - a list of things that aren't going to happen if you are attacked.
    Blame it on Sixto - now that is a viable plan.

  11. #11
    cmb
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    Senior Member Array cmb's Avatar
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    I am in these situations several times a year as a minister. This year seems more than usual I think i have been to 13 funerals and been involved in the service of 8 of those. I pastor a 200ish active member church in a rural community. Four of those I knew pretty well and one was my own grandfather, of the services I have done 6 involved Hospice type care though some were out of the immediate area. This is a real issue and our church has a hospice team... we have a few folks I can call ready to bring information, a friendly face, food, and comfort within hours...

    I think it is responsible to have your plans ready so as not to burden your family (you can do and even pay for pre-arrangments), have papers in order as far as service stuff and legal docs, and have enough life insurance for you needs, etc...

    I have gone as far as to have typed letters to each of my children which I try to add to every few months, so they will know how much I did care if something happened and they will have my words from my heart...

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    This is important stuff, folks. Similar to Dr. Bob's scenario, my friend's mom had an incapacitating stroke (no living will) and the doctor even recommended letting her go. His sister insisted on a feeding tube and kept her alive for another 8 months (never regained consciousness) before she died. The bills wiped out the estate and put an incredible financial burden on my friend (his sister had no problem sticking him with the tab).

    Nobody wanted to argue with her at the time, but these are things that I've already addressed with both the godparents of my son as well as my parents and siblings regarding their estates. It's not a fun topic, but it's best to address it now.
    __________________________________
    'Clinging to my guns and religion

  13. #13
    Senior Member Array DoctorBob's Avatar
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    Quote Originally Posted by cmb View Post
    I have gone as far as to have typed letters to each of my children which I try to add to every few months, so they will know how much I did care if something happened and they will have my words from my heart...
    I suggest to my patients that they see their lawyer and get the requisite papers drawn up, then have a serious discussion with their children, siblings, etc. and make sure that everyone knows what they want and everyone knows that everyone else knows. Updating and reafirming your wishes on a regular basis is an excellent idea. Then you need to approach your doctor and get the POLST data PUT IN Your MEDICAL CHART. This way, everyone is covered and the doctor has a document that s/he can transfer to their hospital chart when necessary.

    Unfortunately, your doctor may not get paid from Medicare for having this discussion with you and so s/he may want to hurry things along. Have an alternative reason for going to the office so s/he can at least bill for something. This was to have been covered in the ACA, and was proposed by a New Jersey Republican, but was dropped from the bill after all that silly crapola about "death panels." My advice... don't let them 'Schivo' you. Get it done the way YOU want.
    Last edited by DoctorBob; August 26th, 2010 at 06:14 PM.

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    Distinguished Member Array Black Knight's Avatar
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    Somewhat along the same lines, on Father's Day 2002 my dad coded out. The Rescue Sqaud and doctors brought him back (sort of). He only had bodily functions everything else was gone. He did not have a DNR on file anywhere. There was a family meeting with the doctors. My brother and I had to make the decision. We decided that since there was no chance of him getting better to not resuscitate him should he code again. He left us about a week later. It was the hardest decision I have ever made. Please don't leave that decision to someone else. Even though I know deep inside my dad wouldn't want to live like that there are still times I question myself about that decision.

  15. #15
    VIP Member Array Guantes's Avatar
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    This is one reason we have a Living Trust, POA, etc.

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