Sea Sick: by Keith Murray
Typically, my monthly column involves medical emergencies at sea. This month I wanted to talk about end-of-life medical issues. Most people prefer not to talk about death and dying, but unfortunately, all of us will die. To quote Benjamin Franklin, ”Nothing can be said to be certain, except death and taxes.”
Living wills and other advance directives are written, legal instructions regarding our preferences for medical care if we are unable to make decisions for ourselves. These documents spell out medical treatments we would and would not want to be used to keep us alive, as well as decisions such as pain management or organ donation. These advance directives guide others in making important medical decisions for us when we are not able to do so. These are typically for people who are terminally ill, seriously injured, in a coma, in the late stages of dementia or near the end of life.
Ideally, these advance directives are put into place early in a person’s life, while they are able to think clearly and plan ahead. They enable us to decide now what medical care we want, avoid unnecessary suffering, and relieve our family (or caregivers) of the difficult decisions that need to be made.
People often ask me at what age should they create advance directives? My answer is age 18. Unexpected medical emergencies happen every day. We see car crashes, shootings, strokes, disease and a variety of other medical emergencies that potentially result in an end-of-life situation. This is why I suggest everyone age 18 and older prepare.
Here are some of the decisions you can make now though your advance directives.
- Mechanical ventilation: If you were unable to breath on your own, how long would you would want to be connected to a breathing machine?
- Tube feeding: If you were unable to eat, would you want to be kept alive by receiving nutrients and fluids intravenously or through a tube in the stomach? If yes, how long would you want to be fed in this manner?
- Dialysis: If your kidneys were no longer functioning, would you want to be kept alive on dialysis for an extended period of time?
- Antibiotics or antiviral medications: If you were near the end of life, would you want infections to be treated aggressively or would you rather let the infections run their course?
- Comfort care/palliative care: Most of us think of Hospice care when we discuss comfort care. Would you want to be given medication to keep you comfortable and manage pain? If you were near the end, would you want to die at home, getting pain medications and avoiding invasive tests or treatments?
- Organ and tissue donations: If you could give your organs and tissue upon death to save lives, would you?
- Donating your body: Would you like to donate your body to science for research?
- CPR / AED: If you were near the end of life, would you want to be resuscitated by cardiopulmonary resuscitation (CPR) or by a device that delivers an electric shock to stimulate the heart (AED)?
If you do not have a living will or other advance directives in place, today is the best day to get one. The rules in the U.S. vary from state to state, and I am certain every country has its own versions of these documents. If you live in the U.S. and would like to do your own advance directives without a lawyer,
Please visit this AARP link and click on your state.
Trained as an emergency medical technician, Keith Murray now owns The CPR School, which provides onboard CPR, AED and first-aid training, as well as AED sales and service (www.TheCPRSchool.com). Comments are welcome below.