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Educational Topics
Health Care Decisions Day
By David Blackmon, Pastor, Previousley Director of Pastoral Care, Mission Hospitals
Health Care Decisions Day is a good time to take stock and ask, “Do the ones I love most know what I value when it comes to care at life’s end?” Tough question! In my role as a chaplain and ethics committee member at Mission Hospitals, I often shared in the stories of patients and families struggling with these decisions. Knowing “what mother would want” at life’s end can be a blessing. Not knowing can create conflict at the most difficult of times. Fortunately, there are some new tools to help in this work. The goal of all of them is the same, to help people make their wishes known.
Fives Wishes does just that. This user friendly advance directive puts hard medical decisions in clear, everyday language. The pages outline lists of choices like who should make decisions when the patient can’t or medical treatments that a patient may want or not want. It indentifies patient values about pain management, guidance about routines of care, and personal statements the patient wants family to know and cherish. It is just one way to record legal directives about medical treatment. Learn more about Five Wishes at http://www.agingwithdignity.org/5wishes.html.
Medical Orders for Scope of Treatment (MOST) records medical choices in a physician’s order. MOST reflects four years of work beginning right here in Buncombe County. The bright pink medical order allows seriously-ill persons with a limited life expectancy to outline specific health decisions with their doctor. This physician’s order is recorded on a state-authorized form that can be followed by other physicians and health care providers, like Emergency Medical Services. MOST takes a big step in making medical choices about life’s end plain. View the MOST form and information about MOST at http://www.ncmedsoc.org/pages/public_health_info/end_of_life.html.
Organ, eye, and tissue donation is a natural topic in a good conversation about end-of-life care. In 2007, North Carolina lawmakers caught up with the general populace by making the heart on the driver’s license legal consent for donation. This means that patient’s have a voice about donation even after death. But, having a discussion with family is vital in knowing why the decision to donate life is important to their loved one. There’s more information at www.donatelife.org. The site links to an online registry that allows North Carolinians to register their decision about organ, eye, and tissue donation.
Decisions about care at life’s end demand some of the same attention to detail as getting that tax return in on April 15. Beginning with what brings joy and meaning to life is a good place to start. Exploring decisions about organ, eye, and tissue donation fits. Reviewing current health status and any future changes demands honesty. Talking to doctor, family, and friends about goals and limits for medical care may be hard. Communicating that plan through advance directives or other means, like MOST, strengthens self-advocacy. And that is the best resource for good care, now and at life’s end. Find even more resources at the North Carolina Center for Hospice and End of Life Care- http://www.carolinasendoflifecare.org/.
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Guest Editorial about MOST
Commentary by Tom Kaluzynski, MD, MemoryCare
One size fits MOST. That’s what the label said on a warm pair of abandoned mittens I found in the closet one cold morning this winter. After finishing my winter chore, I realized that the last few times I used the word MOST was as the acronym for North Carolina’s new document called Medical Orders for Scope of Treatment (i.e. MOST), which serves to outline one’s wishes to have or forgo life sustaining treatment. Recently, the NC General Assembly recognized the MOST form as a legal and portable physician order with the goal of promoting patient self-determined scope of care at the end of life (House Bill 634/Session Law 2007-502). This was not a last minute legislative add on to a hastily put together bill. The MOST form is the result of over four years of dedicated work by many individuals including members of the Buncombe and Henderson County medical communities. My hat goes off to those who put in the time and effort in making the MOST a form that can improve the way we can communicate end of life care goals in the advanced stages of a chronic progressive illness.
Pharmacological and technical advances in the field of medicine often bring up new scenarios that challenge us to ask, “What is the best thing to do or recommend when we are faced with some of the complex issues and emotions related to end-of-life care?” Is there a time in the course of an illness when keeping my mother at home with Palliative Care instead of repeatedly hospitalizing her would be a better approach? As my grandfather’s health care agent, how do I honor his wishes to ‘just let me go when my time comes?’ Each of us will face some of these challenges in deeply personal ways when we are called upon to be involved in such decisions for a family member or close friend.
The revision of the current NC statutes intentionally recognized that a document like the MOST form is a work in progress. Provisions were made to direct the NC Institute of Medicine to report back to the public and to the General Assembly (in 2013) on how, if at all, the changes in Session Law 2007-502 have had any meaningful effect on the goals of honoring and delivering the end of life care that an individual wants. Having a new form will not magically take away the doubt or uncertainty that comes with end of life care. It is important to remember that Advance Directives are tools to move us in the direction of our wishes, but as Dr. Anthony Perkins at the University of Texas Health Science Center in San Antonio recently wrote, they can, “presuppose more control over future care than is possible”. The more critical process is to promote discussion between patients, their health care agents and their health care providers so that when the difficult decisions come, as they most definitely will, the parties involved with have a better map to follow.
Author: Dr. Tom Kaluzynski is on staff at MemoryCare, a non-profit charitable organization serving individuals with memory disorders and their families.
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