Dr. Daniela J. Lamas, a pulmonary and critical-care physician at Brigham and Women’s Hospital in Boston, has penned this profound essay discussing the realities of advance directives and end-of-life care, which appeared in the New York Times on January 6, 2022.
She describes a case in which a patient’s wishes in an advance directive prepared when she was hale and hearty, turned out not to be what she wanted when in the throes of a critical illness: “… what has increasingly troubled me working in the intensive are unit is the difficulty of asking people to make decisions about future scenarios. Humans have an amazing capacity to adapt to illness or disease. From the vantage point of youth or good health, it is easy for people to say that they would rather die than live with significant limitations, pain or dependence on others. But people evolve in ways they cannot expect…As a result, what people are willing to go through to extend their life might change depending on the context. Advance directives written at one point in time about hypothetical scenarios cannot capture what someone actually wants at every point in the future.”
She guides us to a better way. First, no matter what, find that person to be your health-care proxy, to have your health care power of attorney, make sure they agree, make sure they are someone you trust to make decisions for you if you can’t, have the conversation, and do the paperwork.
But second, and most important, “we need to shift the focus from talking to healthy people about what would happen should they stop breathing during a routine procedure and toward improving conversations with people are already seriously ill. All patients for whom these decision are no longer hypothetical should have a documented conversation with their doctor that focuses less on their thoughts about specific medical interventions and more on their understanding of their prognosis, what is important to them and what gives their lives meaning. When I am standing at a bedside in the intensive care unit, I want to be able to lean on that conversation. Is my patient someone who would be willing to go through aggressive medical treatments for the possibility of prolonging his life? Or is this someone who would prioritize comfort given the current medical realities?”
Wow. That’s profound stuff. When I’m seriously ill, I hope I’m in the care of a doctor who is as wise as Dr. Lamas, and I hope that doctor has the legal authority to ease me into a gentle final sleep if and when I so direct. That’s what aid in dying is all about.