PROTECT ME FROM WHICH I CANNOT SEE: WHEN ADVANCE DIRECTIVES ARE NOT KNOWN Dying is not as simple as it used to be. Today preparing for oneâ€™s death can be as arduous as hiring a lawyers to draft a last will and testament, making sure that every last detail of oneâ€™s life is accounted for, to filling out a few simple forms that give an account of oneâ€™s wishes for how theyâ€™d like to die. Thinking and conversing about death doesnâ€™t come easy for most people; Americans especially have a difficult time with the subject. The notion of one day disappearing is contrary to many of our defining cultural values, with death and dying viewed as profoundly â€œun-Americanâ€ experiences.1 However if planning for death is avoided or ignored, it can have profoundly negative consequences for both oneself and the family left behind. Planning for death no longer is simply about what should occur upon oneâ€™s death either. In recent history many cases have been brought to trial concerning oneâ€™s wishes before they actually died. Cases in which the defendants, in many instances, were in persistent vegetative states and did not have their wishes of what they would have chosen to do should such an incident have occurred documented. These are cases in which a simple set of instructions, not requiring drafting from a lawyer but legally binding regardless, could have determined the course of action and protected these persons and their families from years of publicized and undignified suffering. Several landmark cases highlight the absolute need to be prepared for the possibility of death. The cases outline the importance that the preparation be known, specific and documented; and show how these critical elements can help avoid unwanted confusion about end-of-life choices regarding prolonged life-sustaining measures. ADVANCE DIRECTIVES Advance directives are a set of legal documents that allow you to spell out your decisions about end-of-life care ahead of time. They give you a way to document your wishes to family, friends, and health care professionals and to avoid confusion later on.2 The documents can outline one or several aspects of a patientâ€™s end-of-life choices including but not limited to decisions about CPR, intubation, hydration and enteral feeding, administration of antibiotics, dialysis, surgical interventions and durable power of attorney appointments. If choosing to document only one set of instructions a living will is the most important. A living will outlines which treatments you want if you are dying or permanently unconscious.2 In it one can specify key components of life-sustaining measures that one may choose to have enacted or from which one might choose to abstain; this includes the use of dialysis machines, respirators, the initiation of CPR or a gastric feeding tube, and inclusion in organ donation. Of secondary importance, as aspects of it can be outlined in a living will, is a durable medical power of attorney which is a document that names your health care proxy, or someone you trust to make health care decisions for you should you not be able to do so.2 A health care proxy will act in your best interest because you have voiced certain instructions that you wish carried out on your behalf in regards to life-saving or â€“sustaining measures.
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