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How the dying can ensure their wishes are met – Advance Care Directives

How The Dying Can Ensure Their Wishes Are Met – Advance Care Directives

The media is full of stories of older people being given futile and expensive treatment at the end of their lives.  Some commentators say that the focus in our health system seems to be about unnecessarily prolonging the lives of the dying rather than making their death comfortable.

What happens in each individual case should reflect the personal beliefs and choices of the dying person.  Unfortunately where the dying person has also lost their capacity to make decisions about their medical treatment, other people have to make choices about what they think are in the dying person’s best interests.  This may not be the same as the choice the dying person would have made for themselves had they retained their decision making capacity.

Advance Care Directives are a vehicle which allow you to continue to make decisions about your medical treatment even if you lack the decision making capacity to do so.  They allow you to clearly set out what treatment you do and do not want to receive.  This means that the medical staff cannot give you a particular treatment where you have clearly stated in your Advance Care Directive that you do not want to receive it. The Sunday Telegraph’s article yesterday interviewed Professor Hillman an intensive care specialist at Liverpool Hospital who urged people to talk about their wishes regarding end of life planning and to write an Advance Care Directive.

Advance Care Directives give you:

  • Control over future medical decisions involving your health.
  • Peace of mind that you will not be given unnecessary life prolonging treatment where you do not want to receive it.
  • Confidence that your particular religious beliefs and practices will be respected.
  • Knowledge that you will spare your family from having to make difficult decisions about which medical treatments are in your best interests.
  • Security that your wishes are legally enforceable.

Yesterday’s Sunday Telegraph featured a  story about a Sydney hospital trial which will estimate how long a patient has to live so they can decide if they should refuse medical treatment.  When patients receive the results of this estimate they will be able to make informed choices about their future medical treatment and care.  This is also the  perfect time to make an advance care directive so that patients can be sure that those choices will be safeguarded.

Some examples of scenarios where Advance Care Directives can assist:

Scenario 1

Tom is eighty five years old and has Alzheimer’s disease, the disease has progressed and he has lost the legal capacity to make decisions about his health care.  Tom has also developed terminal cancer.  If Tom undergoes treatment for his cancer he can expect to live for another 2 years.  If he does not receive treatment for his cancer he will die within 2 months.  Tom has a son and daughter and they are in dispute about whether Tom should receive the treatment or be left to die peacefully.  Tom’s doctors are trying to ascertain which option would be in Tom’s best interests.

This scenario is difficult as no one knows what Tom would have wanted in these circumstances.  There is now a family dispute and Tom’s children are pitched against each in a bitter battle to decide what Tom would have chosen had he been able to make a decision.

Had an Advance Care Directive been drawn up while Tom still had decision making capacity he would have been able to make his wishes clear. His family would have been confident that the course of action which was chosen was one which reflected Tom’s actual wishes.

Scenario 2

Sophie is twenty two and has been catastrophically injured in a skateboarding accident.  Sophie has suffered severe brain damage and she is in a persistent vegetative state.  Sophie can breathe independently and receives her nutrition through a feeding tube.  Sophie will not recover.  Sophie suffers from continued infections for which she receives antibiotics.  If the antibiotic therapy was ceased it is likely that Sophie would succumb to one of her frequent infections.

Sophie’s parents want her to be allowed to die and they feel that perpetuating her life in this way is undignified and not what Sophie would have wanted.  While the medical staff sympathise with Sophie’s parents they are in a difficult legal position as they feel compelled to treat these frequent bacterial infections.  Sophie did not have an advance care directive.

Had an Advance Care Directive been drawn up before Sophie’s accident she could have made choices about her future medical treatment. This would have meant that her parents and her medical team would have been clear about her wishes.

Scenario 3

Rodney is a Jehovah’s Witness and has particular religious beliefs about medical treatment particularly around blood transfusions.  Rodney has fallen off a cliff and suffered a large amount of blood loss. He is in hospital and needs a blood transfusion if he is to survive.

Rodney has an Advance Care Directive in place which clearly states that he does not want to accept blood products or to have any form of blood transfusion.  Rodney’s doctors have to follow the Advance Care Directive and not give Rodney a blood transfusion as his wishes are very clear, even if this means that Rodney will die.

Advance Care Directives are an important legal tool which allow you to retain control over decisions about your future medical treatment and your end of life medical care.  A clear and properly drawn up Advance Care Directive will mean that your family and medical team will have to follow your wishes about the treatment that you would or would not like to receive.  Talk to our skilled team at Catherine Henry Lawyers for assistance or view our information sheet on Guardianship, Power of Attorney and Advance Care Directives.

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