The Tough Conversation Everyone Must Have
This post is a topic that many are not comfortable discussing. However, I urge you to take time to consider the conversation everyone must have before it is too late. If you are injured in an accident or suddenly become unable to speak for yourself, do you know who would be able to speak for your health care needs? Have you considered the types of treatment you would want? Do you know what type of healthcare decisions a loved one would want if they are unable to speak? Advance Care Planning is making decisions about the type of healthcare you want for yourself before an event occurs. Younger adults often feel Advanced Care Planning is for someone who is elderly or diagnosed with a terminal condition. Not surprisingly, a majority of Americans do not have conversations in regards to what type of medical treatments they would want if they are faced with a life limiting illness. As a palliative care social worker, I reguarly meet with families forced to make tough decisions for a loved one without any guidance because conversations were never had. This past Sunday was National Health Care Decisions Day and today I wanted to share information that everyone needs to have before an event such as car accident, fight or illness occurs. First and foremost (with the exception of someone who is terminally ill and has completed a form) recognize that emergency personnel must always do what is necessary to stabilize someone for transfer to a hospital. Advance Directives are put into place after a physician has assessed a patient’s condition. Advanced directives, which often include Living Wills, are legal and valid throughout the United States but laws do vary from state as well as language. You can download a copy of your state’s Advance Directive form here. Additionally, an advanced directive/living will does not need to be completed by an attorney. A living will allows an individual to name a health care surrogate to make decisions. Without this noted, there is a legal process of who has the right to make decisions. Within the state of Kentucky, there is a legal chain that must be followed. If one is married, the spouse is the automatic decision maker. If there is no spouse, it falls to biological children, followed by parents, siblings and down the biological line. Sadly, a couple who is living together but not married can not make healthcare decisions for each other without a living will. Additionally, if a couple is separated and divorcing but still married, the spouse is still the decision maker. If you are divorcing someone, do you want them to make decisions about your health care? Many name an alternate health care surrogate in case the first is not available. This can be helpful in case a couple is in an accident at the same time. Following the naming of a health care surrogate, one can make note of specfic treatments and considerations that meet your personal values, concerns, spiritual beliefs and views. Here are a few questions you may want to explore.
- What aspects of life give it the most meaning?
- How do your religious or spiritual beliefs impact your view of dying?
- What is your view of death?
- The use of artificial ventilation. A patient can typically be on a ventilator for no longer that 14 days before a decision must be made to have a permanent tracheotomy. This is a surgical procedure and it is possible to be reversed.
- The use of artificial nutrition, fluids and antibiotics. It is important to consider if one would want a permanent feeding tube.
- Aggressive treatment in the way of dialysis, possible amputation of limbs to save your life.
- That you want to extend your life as long as possible with whatever means.
- Allow a natural death to occur if physicians feel there is no cure.
- The level of use of machines and medication.
- They type and level of resuscitation if the heart stops.
- Organ donation
Have or will you be completing an advance directive? Let me know if you have questions.
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We don’t have living wills, but I know my husband and I would automatically be considered the decision makers for each other–he’s a nurse who’s worked in the ICU for years, and has also seen family members make these sorts of decisions many times, and has for himself very strong opinions on what he would and wouldn’t want as far as extreme measures, and has told me. I think medical professionals are especially aware of the importance of having this conversation!
It’s such a difficult conversation, but you’re absolutely right that it’s an essential one to have. I never really gave it much thought, though my parents recently approached me to discuss some of their own medical decisions (they both work in the field, and recently completed their wills). Anyway, I really appreciate you opening up this conversation about this, Sheryl <3
This is a very important conversation to have and it’s a reminder to me that as an only child, I really need to have this conversation with my parents so I know what their wishes are and then it’s probably a good idea to chat with my husband as well. Thank you for all the information, it is definitely important, we just don’t know what tomorrow may bring. <3
Yes, yes, yes. My husband and I have discussed this at length, but we keep meaning to get it in writing so nobody can start an argument about it. I am writing this on my forehead to get it done SOON.
This is a critical conversation. My dad died young so my mom and I were forced to have this conversation about her. I’m not sure if it hadn’t been forced into the open that we would have had it as early as we did. I nagged my husband to have it with his parents. He dreaded it but it turns out they were ready for it and just didn’t want to bring it up w/ their kids. I think that’s the case w/ many of our parents. Can’t stress enough not to wait!
This is so important! I have had a lot of health issues this year and have been asked many times about my living will. I really need to get this done with my husband so we have a plan. You just never know even tough it is so uncomfortable. Thanks for sharing this!
This post is so timely, I actually just had this discussion over the weekend. Especially since my gf’s mom was on a ventilator before she had to make a decision early last year. My mom has been discussing her wishes with me recently too. It’s a difficult talk and something I don’t really want to think about, but definitely essential.
I have soooooo many thoughts about this. My grandfather wanted to go “in peace” and didn’t want any machines keeping him alive. He didn’t actually put this in writing when he was younger, so when he was older, and he saw his grandkids getting older and getting married and having kids, every time we needed to do surgery or work to keep him alive, he’d agree that it’s what he wanted. Because I think in that moment he was emotional and it was hard to say goodbye to his family. So, we kept him alive for 9 years after we initially thought it was time to go. I wonder what would have happened had he put that in writing all those years ago and we made our peace with it 9 years earlier.
It’s such an emotional thing for me to think about. I’m getting teary-eyed just thinking about it. Because as a full-grown, functional, adult with a sound mind, I have a hard time making decisions. So to make a final, firm decision about the biggest thing ever – your life – has got to be one of the most challenging things to do. I don’t know if I’d ever really be certain about what I wanted.
I have mental health issues and if I were to talk about this – it would wave a HUGE red warning flag and my husband would be on the phone with 911 😉
Jokes aside though, it is an important topic to have with your family members. Sometimes I think family members do what they want despite what you want. I saw it happen with my grandma and it was heartbreaking. It wasn’t in writing so there was arguing on who said what and what was best for whom…sigh…awful. That’s why this is important.
Definitely a tough conversation that is hard but very necessary to have.
I know we just discussed this, and it’s something I need to take care of. It’s so uncomfortable and so important. Thank you for the reminder.
Thanks for sharing. This is something that people should think about. I still live at home, but I’ve mentioned things that I’d want to my parents so they know.
-Lauren
http://www.shootingstarsmag.blogspot.com
my husband is in the Army so we had this conversation even before we got married — an extremely important thing to take into account!
Such an important conversation that isn’t the easiest to have, but completely necessary!! Thanks for this. There was information in here that I found so helpful and plan on bringing up this conversation with my husband.
I think this is such an important conversation to have! I freaked my mom out before our vacation to Florida last year when I called, and was like, “If anything were to happen, then XYZ.”
This is excellent — and so important. It’s worth every ounce of the angst over starting the conversation.