My small group discussed the topic of medical ethics this morning. This class, in which most med students complain to be a "touchy feely prepare you to be a doctor" course meets every so often to discuss big topics revolving mostly around patient doctor relationships. The goal of these discussions is to highlight the obvious ways in how to deal with certain circumstances as we will encounter them throughout our med school and future careers.
Usually, our group only has a physician to facilitate the dialogue, but we were fortunate to have a psychiatrist present in the discussion as well to offer some insight, especially in psychiatric cases. Today's talk was a great addition to a small group case we had last week wherein we had a homosexual male AIDS patient present to the clinic, who had appointed his life partner as his proxy but the patient's parents disputed this arrangement and wanted to make the final decisions regarding their son's care. This situation would have been a hot mess if this patient did not designate his partner to be his proxy, which is a person whom the patient entrusts to carry out their last wishes as it pertains to their health care. This brings me to the topic of this blog: advance directives (AD).
This legal document is what physicians base the final wishes of an individual in regards to their health care when they no longer can make their own decisions. In the case of our patient mentioned earlier, he designated a proxy but he could have also outlined his wishes in a document just in case there was any question to what his final wishes were. The basis of an advance directive is to outline what types of treatment a person would want or not want in the event that they are not conscious or incapacitated to make such decisions. Do you want a feeding tube? Do you want cardiac resuscitation? Do you want to be on a respirator to keep you breathing? There are more questions like these and all clarify what exactly you would want. In addition, an AD asks what you would like to do in terms of donating organs.
Well, after today's discussion on such morbid topics, I started thinking just how important this document reall is. Death is something most people do not like to discuss, I imagine. But, it is a really important topic as it pertains to how people like your loved ones would handle your last days in this life and how to properly carry out your wishes once you have past on. It would be difficult to lay such a heavy burden on your spouse, children or siblings when they may feel complete guilt in "pulling the plug" when that might have been your wish all along. I guess I could make this blog my advance directive in saying that I would not want to be on long term artificial respiration especially when I am "brain dead" and obviously not conscious to breathe on my own but a machine is the only thing keeping me alive.
I guess my main concern on this and why I am writing a blog about it is that there are too many loopholes that can be created if your final wishes are ambiguous. The Terry Schiavo case comes to mind on this. Terry's parents fought her husband on pulling the plug. One of the main reasons why it was stuck in court for so long was that she did not have a plan set out just in case something were to happen. This is not unique to her, as I would bet most healthy young individuals do not plan just how they would like their end of life care to be handled.
The discussion just got me thinking...should I fill one out just in case? Or am I being overly concerned and a control freak?
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