Posted on September 4, 2019 at 8:08 AM
I have been thinking about this for a while, and even more
since I recently retired from practicing medicine (but not from teaching) and
realized while working through our retirement plans that my current will
contained instructions about who should care for our young children if my wife
and I would both die. Well, those children are now 40, 37 and 34. They have
their own children and will be fine on their own when we die. I need a new will
and one part of that is that I need to decide who will make medical decisions
for me when I am unable to do so for myself. All three of our children share my
values and will make excellent decision makers for me, but I want them to have
something to go by, so they understand how I want those decisions to be made.
After all, I have been a physician for over 40 years and I teach bioethics, so
I should be able to give them some guidance.
My decision to post these guidelines publicly is in part
based on what Ezekiel Emanuel did about 5 years ago when he wrote about no
longer doing any medical treatments that focus primarily on prolonging life
after he turns 75. As Neil Skjoldal wrote a couple of days ago, Emanuel’s plans
are driven by his concept of what makes life meaningful. My concept of that is
different. Being creative and productive are important, but meaning in my life
comes from my relationship with God, and that impacts how I want medical decisions
made for me. So, here is what I wrote to my children.
Principles for making medical decisions for me when I become
unable to make my own decisions:
human life has value because we are made in the image of God, so nothing should
be done with the intent of ending my life even to avoid suffering.
though human life has great value my eternal relationship with God has greater
value than my life on this earth, and that relationship will continue after my
death, so it is not necessary to do everything possible to prevent my death.
about medical treatment should be made based on whether the expected benefit to
me is more than the expected burden to me from the treatment. They should not
be made based on an idea that my life itself is burdensome.
Examples of how to apply these principles:
I am dying and death is expected soon, no treatment should be done other than comfort
care. Sedation is appropriate if needed to control pain or behaviors that are
harmful to me or others. Comfort care can usually be done outside of a
hospital, but professional caregivers should be used as needed.
treatments such as antibiotics for an infection and minor surgical procedures
should be done if it is expected that I will benefit from them and there is
little risk involved.
treatments such as ICU care, ventilators, chemotherapy, major surgery and other
invasive procedures should only be done if I have a reversible condition and it
is expected that they will only be required on a short term basis. Such
treatments can be done on a trial basis and stopped if they are not effective.
This type of treatment should not be done if I have a condition that I am dying
from and the treatment will only prolong the process of dying.
use of feeding tubes can be a difficult decision. Feeding tubes may be used if
they can be used on a short term basis to help me recover from a reversible
condition. If the condition I have is irreversible, I would prefer to be fed by
mouth to satisfy my hunger and thirst as well as possible, even if feeding by
mouth may have some increased risk.