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Feeling a loss of control during the COVID-19 pandemic?
Many of us are feeling a loss of control over our lives and our bodies during this overwhelming viral pandemic. It’s important that we focus on the things we can control. Now is a great chance to focus on our advanced directives. (medical and legal documents stating the person’s choice to be left to die naturally or to have some or all intensive invasive medical therapy)
Types of advanced directives include:
Living Wills — legal documents that outline what you want to have done in the way of aggressive medical care if you are in a terminal medical state, or in a condition which could be terminal, and you cannot speak or express your wishes, such as being in a coma.
Health Care Surrogate or Medical Proxy—allows you to choose a friend or family member to make medical decisions for you if you are ever unable to make those decisions yourself. This person should be someone you know and trust. They need to know your wishes for the level of aggressive and invasive medical treatment that you want to have done if you are unable to communicate to your medical team.
Natural Death (Do Not Resuscitate) — When you die at home, in a nursing home or in a hospital, you have the right to notify your family and healthcare team of your wish for a natural death.
With natural death, you are allowed to have all the pain, breathing, medical support you need and then when you die, your body is left in peace, your family does not have to suffer seeing your body aggressively having chest compression and hearing the ribs break or multiple IV lines, tubes and machines put in your body, if your heart stops beating. When your heart stops beating at the end of a long illness or a wonderful long life, this is the natural progression, the natural conclusion to our life. You deserve to have a quiet peaceful natural death with family and friends. No amount of aggressive measures will change your state of health FOR THE BETTER at the end of a long illness or a long life.
Resuscitation using advanced cardiac life support using CPR methods, electrical shock and ventilator support was created to rescue someone whose heart stopped beating abruptly. For example: trauma, overdose, poisoning, heart attack or other acute injury. ACLS and CPR were created for that 20-year-old near drowning victim, that 55-year-old with a heart attack while mowing grass, that 15-year-old that overdoses on pain medicine. For these people, ACLS is incredible and many of them to make a full recovery with more years of healthy active life. It was not developed to restart a heart at the end of a long life or a long illness
Taking the time to complete these advanced directive forms, allows you to communicate with your family, friends and medical providers what your exact wishes are especially if you are unable to communicate those wishes yourself.
The legal document know as a Living Will allows you the control to decide the types or intensity of medical interventions you are comfortable with receiving. Some interventions are logical no matter your survival chances, such as pain control, anxiety control, or anything that helps maximize your comfort. But, living your last 2-6 months of life in bed unable to do anything for yourself may not be your idea of an acceptable end to your life.
Communicating in writing the medical interventions which you are comfortable experiencing is your right. Discuss these with your professional care provider, like your Physician, Nurse Practitioner or Physician’s Assistant.
Again, you are in control of this process! You can always change your mind and ask for the more aggressive care at any time. Even though you don’t choose to have aggressive measures you are still entitled to medical intervention giving you with the best care and comfort to keep you from being in pain or suffering.
Advanced Directives and COVID-19
With the current pandemic and virus, it’s important to know that once you are put on a ventilator, you may have as little as a 20% chance of survival and that percentage goes down the older you are or the more chronic illnesses you have.
It is your privilege to request all measures be taken or to refuse being put on a ventilator so that if you die, you die in peace and have a chance to say goodbye to your loved ones. This is something to have in your Living Will and to discuss with your Health Care Surrogate.
In these types of situations, CPR (resuscitation) has no or an exceedingly small possibility, of returning you to consciousness and to a healthy future life.
COVID-19 is an unpredictable viral disease
To decrease your anxiety, here are some questions to consider in case you get sick.
#1. What is your current health and what is your wish is if you’re so sick your chance of survival is small?
(Current chance of surviving if you need to be kept alive by a ventilator is 15% but that varies by
age, sex, and additional health conditions)
#2. Do you want the opportunity to say goodbye to family members in case you don’t survive this virus?
(Some people are on the ventilator for 2-3 weeks before they die or get better)
#3. Could you survive this virus if you refuse to go onto a ventilator? And, if how much will you suffer if
you make either choice? (You need to hear your healthcare team tell you what they will do)
Health care providers want to prevent or minimize your pain and discomfort.
#4. If you or a loved one require intensive intervention to survive; ask your healthcare team these important questions:
What is the worst-case scenario with and without intensive (and invasive) treatment?
How much will this intensive (and invasive) therapy increase my chances for a full recovery? For a partial recovery?
How badly disabled will I be if I do this therapy and survive?
What happens if I chose NOT to do this intensive therapy?
Will you help with pain? With anxiety? With trouble breathing.
#5. Would this current healthcare provider choose this invasive therapy if they were in this same
situation?
Most elderly people who has are infected with COVID-19 virus and then develop severe pneumonia will need a ventilator to stay alive. As few as 15% of COVID-19 patients who are put on a ventilator will survive. Once on the ventilator you are unable to talk to your family and loved ones. Most will die after 2-4 weeks on this breathing support and never talk to anyone again.
But, they have the right to be in control here especially if family and healthcare team are already aware of the persons Advanced Directives decisions.
So, if you have little chance of survival even with the ventilator—remember it is your life and your body. You can choose care and comfort measures to minimize suffering and maximize interactions with your family and loved ones before your life ends.
There are no easy or correct answers to these decisions. They are hard decisions and discussing them before getting sick helps patients and their families have more control, less anger, less frustration and minimizes their anxiety, when that life-ending illness/injury occurs.
Other Resources:
https://hospicefoundation.org/Hospice-Care/Advance-Care-Planning
https://www.nia.nih.gov/health/understanding-healthcare-decisions-end-life
Great Book
A Beginner’s Guide to the End: Practical Advice for Living Life and Facing Death
By B.J.Miller and Shoshana Berger.
Chapter 3 discusses Advanced Directives in excellent and compassionate detail.
https://www.goodreads.com/en/book/show/42202807-a-beginner-s-guide-to-the-end