Advance Directives

By: Matt Ryan

CNN had an article this week about end-of-life decisions. To begin, I want to state that I am not a healthcare ethicist. CNN touched on the difficulty of end-of-life decisions. Commonly, close family members and friends stand to make the decision whether to continue their loved one’s life. In the recent discussion during health care reform, the discussion was often framed in a very poor light. At its worst, some argued that those who supported physicians providing advice and letting the patients know of their options before they lost the capability to choose were “killing granny.” This is a shame, and I think we as a society need to have an honest dialogue about end-of-life care so that we can better handle these extremely difficult situations. To begin, a recent study has shown that 1/3 of Americans have had to make end-of-life decisions. This issue is evident throughout our society so it must be discussed.

The CNN  article touched on how agonizing it is for family members to choose end-of-life decisions. At its worst, some feel they are killing the ones they most love. If they choose further treatment, they feel they are prolonging suffering. As you can see, all options are difficult. In public health, we must recognize the challenge. We must recognize that the answers will not be easy, but we must consider that there could be population-based decisions to make this process easier. This is a justice issue. Not only on how life is treated at all stages, when considering the patient, but also on how family members and friends are affected. We need to ask ourselves if their are population efforts that can ease the process.

The CNN article concluded by stating that the agonizing was less difficult if an advance directive was established. In other words, the patients had told the family members how to choose when the time came. An advance directive is also known as a living will. We as a society must consider making advanced directives more frequent. We must find the balance that this is not a call for death panels, but a rational decision. In CMH-365, we are realizing that answers are not easy. We are realizing that we must hold multiple thoughts in tension. We cannot run from the reality that death is inevitable, and making the decision for others may occur, but in doing so, we also cannot lose respect for the life of those most in need. In public health, educating others on these difficult choices may ease the agonizing. Acting early so that decisions are less difficult later is a core tenet of public health. Facing the harsh realities of life is also a core issue of public health. Understanding this, I have begun to ask the question if advance directives truly work. If so, how common are they? I also wonder if simply instating a policy for physicians to  inform patients would work, or if this needs to be a more comprehensive effort? One article cannot answer these longing issues, but I just wanted to bring awareness to an extremely difficult topic.


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