KEOM & ElderHope : Advance Care Planning & CPR
Posted by Chapster on May-01-2003 (2455 reads)

This is the script from our May Community Focus segment. It deals primarily with CPR and Advance Directives.

Advance Care Planning:CPR
KEOM 88.5FM & ElderHope
Taped April 29, 2003

Q: So, Mike, last month we began talking about ways to plan for serious and terminal illness using Advance Directives. You said that we were going to spend a little more time on that.

A: That’s right. We listed several concerns last month. First, that so few of us have an Advance Directive, which should include a Durable Power of Attorney for Health Care and a Directive to Physicians, or Living Will, as they used to be called. Both of these are really necessary. Secondly, we also mentioned that, in many cases, people have not shared their wishes with their family, which has the practical effect of making whatever Advance Directive is in place, useless. Finally, when Advance Directives ARE written OR discussed, the document and the discussion are not specific enough.

Q: And that’s where we stopped?

A: Right. With the promise of spending a little time talking about options in end-of-life care. One option that should be discussed is the extent and circumstances under which we would want CPR or Cardio-Pulmonary Resuscitation. We might ask ourselves if we would want CPR if we were terminally ill. Would we want it if we had been through several strokes? Would we want it if we were having problems during surgery? When would we want to have this done.

Q: How invasive is CPR?

A: It is very invasive. For elderly and frail people, manual CPR often breaks ribs, sometimes creating further complications. The electrical simulation is also very painful. Certainly, there are circumstances where I most certainly WOULD want it. There are also circumstances where I would not want to have it done, such as if I had a terminal illness. I would also not want to have CPR if, in the opinion of two physicians, I could not be restored to a quality of life where I could interact meaningfully and purposefully with my loved ones. If I have an illness that would, in the natural course of things, take me anyway, I would just want to be able to die. But, that is not true for everyone, and this should be honored.

Q: Is this addressed in the written Advance Directives?

A: Yes, it is. Or, at least, it should be. Again, however, the SUPPORT Study of 1995 showed a significant percentage of the time, physicians have NO IDEA what their patient’s Advance Directive says, even if there is a copy of it readily available for them to read. So, it is absolutely necessary to convey this to your family or surrogate decision-maker. They need to know this in order to be able to convey it to the medical staff.

Q: It seems like a lot of our feelings about this depend on where we’re at in our lives.

A: Indeed. Paper can’t readily communicate the decision-making process that YOU would go through. Our families would often feel guilty if they, to quote what I hear very often, “Do everything possible for us.” The rationale for our decision needs to make sense to them. So, for instance, as I mentioned earlier, from where I am at in life right now, if I were terminally ill and I was facing a great deal of pain in the latter stages of my illness, I would go to, ahem, great pains, to make sure that my wife, Barb, and others knew that I would not want to be resuscitated. I have even explained this to my eleven year old son. And, it makes sense to him. In fact, in one of these discussions, he told me, “You know, Dad, I want the same thing. If they can’t make me where I can run and play games, I don’t want to be that way.”

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