How can we gain some control over our healthcare in a time when control seems lacking? Everyone has seen or heard of the heartbreaking examples of Covid-19 patients intubated and on ventilators. Many are older and medically compromised, but certainly not all, and the rapid rate of progression from mild symptoms to needing ventilator support is shocking. Statistics currently show that between 50 and 80% of patients who require mechanical ventilation for Covid-19 die, and that 80% of these deaths occur in those over 65 years of age.
Critical decisions need to be made rapidly at such a time, and if the patient has not previously been clear about their wishes, the doctor turns to the next of kin with the question: “What would your loved one want?” All too often the response is: “I’m not sure, we never talked about it”. Unable to even be present with thepatient, family members are confused and distressed, more so if there is no advance care plan or designated decision- maker (healthcare proxy).
While a majority of Americans support the idea that one should make a healthcare plan for one’s final days, only 37% have actually put plan to paper or designated a healthcare proxy. When patients are without either a written plan or someone to make medical decisions on their behalf, medical personnel are duty bound to take the default approach of aggressive treatment which may include intubation, mechanical ventilation, CPR, and dialysis.
Communicating your wishes for end of life care does not need to be complicated. In this time of “shelter in place,” email, text messages or video can be used to tell loved ones what you do and do not want under certain medical circumstances. Designating someone a healthcare proxy to carry out your wishes is an important first step. Getting your wishes documented and in the hands of your medical practitioner ensure you will be heard. Websites that can help you organize your thoughts and options can be found on the internet:
The Conversation Project The Five Wishes The Stanford Letter Project
Locally, Healthy Peninsula and committed community partners offer Choices thatMatter—free resources, education and practical support and assistance to help encourage conversations about end-of-life care planning long before a medical crisis. Find resources and information at https://healthypeninsula.org/initiatives/healthy-aging/choices-that-matter/
In the time of COVID-19 there is no room for procrastination. JUST DO IT!
Barbara Sinclair, PhD Susan Ostertag, MD
Choices That Matter Volunteers