|
 |
 |
|
|
You Must Inform Family of Heath Care Decisions-Part 2
Jan L. Warner & Jan Collins
More about controlling your health care decision-making when you are unable to express your wishes. . . . .
In planning for health care decision-making, there are three areas that should be dealt with: 1) Life vs. Death: Under what circumstances, if at all, should medical treatment, artificial nutrition, and hydration be withdrawn to allow us to die a natural death? (2) Continuation of Life: What medical treatment should be provided – or not provided – when medical decisions do not involve Life v. Death issues? (3) To whom should medical personnel turn for guidance in making these decisions for us if we are incapacitated or otherwise unable to express our treatment preferences?
LIFE vs. DEATH DECISION-MAKING
Public awareness about end-of-life issues increased exponentially in 1990 after the United States Supreme Court made its first declaration about “right to die” issues in the Nancy Cruzan case. The Court recognized that the right of individuals to refuse unwanted medical treatment and artificially delivered food and water was a liberty interest that was protected by the Constitution. The Court said that so long as there was “clear and convincing evidence” of the patient's intent, life-sustaining treatment could be withdrawn.
Through the Cruzan decision, the Supreme Court established flexibility among the states to set the parameters within which appointed agents could make the decision to withhold or withdraw life-sustaining treatment on behalf of a patient who could no longer express his or her treatment preferences. The documents used are collectively called “advance directives” or “advance health care directives.”
In varying formats, each state (and the District of Columbia) now allows individuals with mental capacity to give written directions about life-sustaining treatment preferences to their agents through either a living will, the more flexible health care power of attorney, or, in some instances, a medical directive. None of the authority granted in these documents can be used by the agent until the signer is unable to make decisions on his or her own behalf.
Written directions for end-of-life treatment of a patient who can’t express his or her preferences become applicable in two basic circumstances: 1) the individual has a “terminal condition,” or 2) the individual is “persistently vegetative” or “permanently unconscious.” While these definitions may vary from state to state,
a “terminal condition” is generally defined as an incurable or irreversible condition that, within a reasonable degree of medical certainty, could cause death within a reasonably short time if life-sustaining procedures that prolong the dying process are not used.
“Permanent unconsciousness” or “persistent vegetative state” generally means that the individual is in an irreversible condition with no awareness of self or surroundings. Only involuntary vegetative or primitive reflex functions controlled by the brain stem -- such as eye movement, spontaneous respiration and certain protective reflexes -- remain. Because these conditions don’t allow the patient to swallow, food and water are delivered through a surgically implanted tube.
When engaging in end-of-life planning, there are legal differences between “life- sustaining medical treatment” (such as respirators) and providing hydration and nutrition through surgically implanted tubes.
For example, Nancy Cruzan, an accident victim who was persistently vegetative, was first sustained by both a respirator and feeding tubes. When the respirator was removed, Nancy began to breathe on her own and her life continued due to the hydration and nutrition provided to her body through the surgically implanted tube. Because it was medically impossible for Nancy to regain cognitive functioning, her parents asked that the tube be removed, an act that would result in her death. The hospital refused, and the Supreme Court decision was based on the removal of the feeding tube.
Next week: Making end-of-life decisions and planning for other decisions during incapacity.
Need more advice or help with this topic? Click here to get information about taking the "Next Step".
|
© 1986 - 2012 Jan Warner. Please See our Terms of Service and Privacy Policy.
Please feel free to contact us with any comments.
Planning Your Future with 20-20 Vision™
|
|
|
 |
|
