Sunday, April 25, 2010

For My Friend. This ones for you.

The other night I was at a friends 40th birthday party and I was discussing my new business with some friends.

One of my girlfriends shared with me that her mother is going through the advance directives issues with her grandmother.

My friend explained that her grandmother never wanted to be in the nursing home. She said she does not want to be resuscitated and she did not want any “heroic measures.” She mentioned to me that the nursing home called her mother about administering intravenous antibiotics and her mother was not sure what to do.

When I speak with my clients I go over just this.

The perception of heroic Measures run the gambit. Some think of them as only medication to facilitate blood pressure and cardiopulmonary resuscitation. Others think about heroic measures including artificial respiration, artificial nutrition and hydration, intravenous medication, antibiotics. Their is no hard fast rule to this as of yet.

Ultimately it depends on what you believe and your goals of care. You, being the patient if you are able to make these decisions for yourself or you as the person charged with making these decisions for another (you, being the surrogate).

I suggest asking the following questions when speaking with anyone from a facility requesting consent for a procedure of any kind.

I. Find out the name, the title, how long has this person been working with your loved one?

a. Who you are talking to is important.

b. The explanation will be different based on their level of education and if they are just a consultant on the case.

c. If need be request to speak with the physician or the charge nurse if a satisfactory explanation was not given.

II. Ask, what do you expect to accomplish with this measure (ie.Antibiotics, hospitalization, Medications)?

a. Restore present state of health or provide comfort.

1. This will allow you to decide if this is inline with your family member's personal goals?

III. What are the overall goals of care?

a. Sometimes the treatment that they are seeking to administer may not be in line with the overall goals of care.

b. Asking this question assists everyone in clarifying the overall goal

IV. Summarize and repeat what this person has said to you.

a. Perception is everything.

b. Paraphrasing and reviewing ensures you received the information the sender was intending to deliver.

V. Ask yourself are these in line with the goals that your loved one has shared with you or what you think she/he would want if she/he was able to make this decision right now with the facts you have in front of you based on his/her present state of health?

a. Make the decision a factual decision not an emotional decision.

b. It is a decision you are making based on the wishes of another.

Don’t perpetuate this situation. This process causes emotional stress and guilt that lasts a life time.

Make your wishes known to your family and loved ones and memorialize it in a Health Care Proxy Form.


  1. This is a critical issue that has to be addressed by families, and yet is a very hard subject to bring up. Without this dialogue, families are left wondering. Pat Iyer

  2. Yes I agree with all. Thank you Pat. I have no problem bringing this up at all. I know it is a dirty conversation. This is not about death. It is about life. What is an acceptable level of disability to you?