Case emphasizes need for end-of-life discussions

Have you ever wondered whether it's worthwhile to have a Health Care Directive (also called a health care proxy, personal directive, power of attorney for personal care) made up to express your wishes? If you've ever considered it unimportant,click here to have a look at this article from www.advocatedaily.com. Right now, the Supreme Court of Canada is deciding an essential issue for all of us. They are looking whether doctors have to listen to the person who was appointed under a health care directive when the doctors think it's time to pull the plug on a person in a vegetative state.

The case centres around Mr. Hassan Rasouli. Mr. Rasouli's doctors believe that he is in a vegetative state and will never recover higher functioning. His wife was named by Mr. Rasouli in a health care directive and opposed the doctors' suggestion that life support be discontinued. Had she given her consent, life support would have been withdrawn, allowing Mr. Rasouli to pass away naturally.

The court will decide whether in a case like this, the doctors need the consent of a substitute decision maker to give treatment that they see as ineffective or inapproprite. In case you are getting the impression that the doctors are fighting to end this man's life, please understand that the doctors need and want this clarification by our  higher court as much as Mr. Rasouli's family - and the families of anyone who is on life support - want it. Everyone needs to know where this issue stands.

Each of us should have this document prepared appointing a trusted loved one or friend, and discuss our wishes with that person.

Are we ready to die with dignity?

This Globe and Mail article is right when it says that end-of-life decisions are not talked about enough between family members. I know it's not a fun thing to talk about; I've witnessed enough tears in my office just talking about end-of-life matters in general to know that nobody's enjoying the topic. But it's so important, as this article mentions. Please click here to read it and gain some perspective on these issues. The attached photo is also from that article.

Opposite of DNR

Not long ago I received a question on this blog that asked me how to word a personal directive so that "the opposite of DNR" was achieved. The person didn't want "some idiot pulling the plug" and wanted to know how to word the document so that "the only reason I should be dead is old age". I've heard similar comments a number of times, so I believe this question represents the thoughts of many people.

I don't believe that there is any generic wording that suits everyone, and I am not prepared to suggest any wording of any document to someone when I don't know all of the relevant facts. However, I do want to talk about the general issues that arise from this person's question. I believe that many people don't really understand how the Personal Directive (aka heath care directive, advance directive, power of attorney for health) works.

The first thing that strikes me is that the person asking me this question shares a misconception with a number of other people I've met. That is, that signing a directive somehow gives medical professionals permission to prematurely and frivolously end someone's life. That is simply not the case,. The permission given in the directive says only that if the person is in a vegetatative state and no matter what is done, the person will never recover, then it is alright to discontinue artificial support. Nowhere are you giving permission for someone to kill you should you inadvertently fall asleep and not be able to watch your back. I doubt there are many practicing doctors out there who can't tell a functioning person from one in a  vegetative state. Personal Directives usually also contain specific instructions that direct that nutrition, hydration and pain-killers continued to be administered.

The doctors I've talked to about this tell me that if they believe that life support should be discontinued, they talk to the family and set a date for it. There is nothing hasty or spontaneous about it and there is plenty of time for the family to talk it over with each other and with the doctors.

Many people express to me a fear that the plug will be pulled too soon, and they will lose the chance to recover. As has been pointed out to me many times during these discussions, people do recover from comas. The problem here is that a person for whom life support is going to be discontinued is not in a coma. A person on artificial life support has no brain function at all. The only thing keeping them alive is a machine that pumps their heart or their lungs. What are the odds of recovery?

Also remember that the person who has the authority to speak for you on health decisions is not the doctor. Only the person you chose and named in your document may communicate your written instructions about how to handle the situation. So to have someone mistakenly try to remove life support, not only would the doctor have to be "some idiot", your chosen representative would also have to be one.

I'm glad the issue was raised, as this is one of the concerns bothering people who are trying to do their estate plans and trying to understand how the Personal directive document works.