Life Or Death Decisions Are Never Easy

The document that is often most difficult for my clients to sign is the Directive to Physicians, or living will, as many call it.

It forces you to consider the potential that you may one day be lying unconscious in a hospital room with no hope of recovery, and puts you in the position of dictating to your loved ones how and when to end your own life. Thinking about issues like this can make anyone depressed.

What Are Your End Of Life Wishes?

Many would agree that they would not want to be kept alive by artificial means if they are significantly brain damaged and won’t be able to live a meaningful life; however, the circumstances are not always black and white.

For example, consider the case of Shelli Eldredge (video above), who slipped into a coma after suffering a fractured skull and brain injury in a moped accident. Doctor’s did not expect her to recover and one even suggested terminating life support. But her husband declined. And it’s a good thing. A month later, Shelli started showing signs of life and a few days later, she was talking, moving and well enough to leave the hospital. Besides some difficulty walking, which is improving with physical therapy, she’s able to live a normal life.

Shelli Eldredge was fortunate. Many people in a coma with severe brain injuries never recover. I read an article recently about Edwarda O’Bara, who had slipped into a coma when she was 16 years old. Her parents cared for her in their home and fed her through a feeding tube until they died. At that point, her sister took over her care. In all, she spent 42 years in a coma before she died.

Communicating Your Wishes with a Directive to Physicians

The Directive to Physician is a document allows you to instruct your physicians to administer, withdraw or withhold artificial, life-sustaining treatment in the event you are diagnosed with a terminal or irreversible condition and are you unable to make your own health care decisions.

You get to decide whether you want doctors to withhold all treatment other than those required to keep you comfortable, or in the alternative, whether you would like to be kept alive in your condition using available life-sustaining treatment.

As I read Edwarda O’Bara’s story, I wondered what decisions she would have made.

Terminal and Irreversible Conditions

The document allows you to indicate your preference in two situations. The first addresses what should happen if you have been diagnosed with a terminal condition, while the second section addresses what should happen if you have been diagnosed with an irreversible condition.

A terminal condition is defined as an incurable condition that will produce death within six months even if life sustaining treatment as provided.

An irreversible condition is defined as a medical condition that:

1. May be treated, but is never cured or eliminated;
2. Leaves a person unable to care for or make decisions for himself; and
3. Is fatal without life-sustaining treatment.

The section dealing with irreversible conditions gives many people pause. The statute explains:

“Many serious illnesses such as cancer, failure of major organs (kidney, heart, liver, or lung), and serious brain disease such as Alzheimer’s dementia may be considered irreversible early on. There is no cure, but the patient may be kept alive for prolonged periods of time if the patient receives life-sustaining treatments.”

It’s important to note that the Directive only becomes effective if you are incapacitated and unable to make those decisions for yourself. In addition, the Directive can be revoked by you at any time, even if you are incapacitated, so long as you are able to communicate your wishes. You should discuss your wishes with your family so that they have a clear understanding of your wishes.

Personalizing the Directive

In addition to indicating whether you would like to discontinue available life-sustaining treatment, you can also personalize the directive to reflect your unique circumstances.

For example, if you have chosen to have life support terminated if you have a terminal condition and are not expected to recover, you can request that you still get pain medication to keep you comfortable and that you are able to live your last days at home if at all possible without unduly burdening your family.

Why Sign a Directive?

Although signing a directive is difficult, there are many reasons to sign one. Obviously, the directive lets you specify your end of life decisions and puts you in control of what life-sustaining treatment you receive.

For example, as I read Edwarda Obara’s story, I realized I wouldn’t want to live like that.  I wouldn’t want my family to give up on me too soon. Like Shelli Eldredge’s family, I would want them to give me every possible chance to recover. But if the circumstances were hopeless and I would never be able to live a meaningful life, I wouldn’t want to be kept alive artificially in an unconscious state for decades.

This is especially so in light of a study suggesting that some people in vegetative states are in a conscious state. I can’t imagine being conscious and yet trapped in a body that can’t move or communicate for a lifetime.

Signing the directive also relieves your family of the burden of having to make that choice on their own. In the event family may disagree about how to proceed, having a directive can also prevent any conflict that may arise.

Making your decision

Deciding when and under what circumstances life-sustaining treatment should be terminated is a deeply personal one. It deserves serious thought and consideration. Before making their decision, I recommend that my clients talk to people they trust, such as their family members, physicians and clergy.

What often comforts my clients is that the Directive is not written in stone. If you change your mind at any time, you can revoke it and sign a new directive that is more in line with your new wishes.