What you should know about
advance directives
By Andrew Mleynek, DO
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Advance directives and living wills may not be everyone's idea of happy conversation, but these very important documents should be included in your list of important topics to cover with your family. That's because these documents become your voice in the unfortunate event that you become a patient and are unable to speak for yourself.
An advance directive clarifies patients' wishes to physicians and hospital staff as to the different types of treatments they want, but often more important, what they are sure they don't want. Cardiopulmonary resuscitation, cardioversion (electrical heart stimulation), intubation, feeding tubes, catheterization and mechanical ventilation are some of the procedures and treatments that many patients have decided they do not want, especially in the event of a terminal or poor prognosis. However, without an advance directive, a matter of law can force physicians to ignore these wishes.
I was pleased to be asked to present my views on this topic at a recent community forum sponsored by Northern Nevada Medical Center. I was thrilled to hear presentations by a hospital social worker, lawyer and a professor of ethics from the University of Nevada, Reno (UNR).
Judy McCarthy, Northern Nevada Medical Center case manager/social worker, is concerned on a daily basis that all patients are given clear and complete instructions for advance directives. She witnesses the dilemmas experienced by patients and their families when these critical decisions have not been made in advance. The lack of clear direction can result in arguments among family members.
Attorney Richard Schulze was concerned with the legal interpretation of advance directives and living wills as well as the difference between the two. He also emphasized that everyone, regardless of age, should complete the documents, discussing the recent Terri Schiavo case as an example.
Noel Tiano, ThD, director of UNR's Nevada Center of Ethics and Health Policy, was concerned about religious beliefs, citing his personal experiences as a minister and overwhelming misinterpretation on the subject. He primarily projected a positive attitude in dealing with the subjects of dying and having a "good death."
We are a young nation born from revolution with a fighting spirit. It is our "never give up" attitude that makes this country great, but it has hindered our ability to cope with the fact that we will all die one day. Death is viewed as failure, even in our medical school education.
However, it is not enough just to accept death. It is also important that we honor and celebrate life. Preserving dignity and allowing for a natural death is both noble and kind. Spending their last days in a hospital gown attached to tubes and electronic devices can be cold, lonely and unsettling to patients and their families. This anguish can interrupt and prolong the grieving process, whereas a dignified and peaceful death can soften grief and allow for more positive memories.
I encourage everyone to complete an advance directive to specify his or her own wishes as they pertain to healthcare. Designate a representative who knows and agrees with your wishes and can speak on your behalf. Parents especially should have a living will and discuss care of their families and estates in the event of death or incapacitation.
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 Andrew Mleynek, DO |
Without these documents, we leave important and often painful decisions to people who may not know us. As a family physician, I am concerned about the well-being of my patients during all phases of life, including death.
Andrew Mleynek, DO, is a family physician with Eastern
Sierra Medical Group, 3967 S. McCarran Blvd. at Longley.
For more information or an appointment, please call
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Northern Nevada Medical Center 2375 E. Prater Way, Sparks, NV 89434 775-331-7000 |
