MAKING SENSE OF HEALTHCARE DIRECTIVES

Do you have a healthcare directive? This daunting question is posed to Emergency Room patients daily and is often received with a virtual shrug and response, “Do I need it today or may I think about it?” Being an Emergency Medicine physician, I can attest to people making and taking little time for life and death decisions. National Healthcare Decisions Day (April 16) draws attention to the importance of advance care planning. However, I propose healthcare directives actually make sense when they empower lives rather than confuse people.

Healthcare directives will never make sense until death makes sense personally. At times, death and dying does make sense. As such, a futile medical condition would not incur the onslaught of a full code. End-stage heart disease would not demand resuscitating the heart when it stops. Terminal cancer would not call for a continuum of heroic measures. If it makes sense to provide more dignity and less suffering through healthcare directives, people might be inclined to enact healthcare directives that seem less punitive, more compassionate and intent on dying.

The arc of a reasonable healthcare directive follows the heart’s intuition as its pulse rate naturally determines responsiveness. The heartbeat holds steady during Preventative care and increases with Advance care. Missed beats and milestones become a pivotal point for receiving Palliative care. The ultimate downside or turn for the worse anticipates the delivery of Omega care. Herein, the heart is allowed to rest and dignity becomes finite to the law of nature. The normal bell-curve of illness reflects the natural upswing and downturn of life. Unorthodox thinking in both healthcare directives and life would attempt to turn back the hands of time.

Healthcare directives make sense as standard care when life-sustaining measures are not granted to patient with poor prognoses. When patients receiving Palliative care takes a turn for the worse, could Omega care be automatically provided without further deliberations and coercions to save the life at all costs? Can we as a society evolve on this topic and begin to talk seriously about healthcare directives that would uphold the dignity of dying patients beyond wishful thinking; thus, averting senseless acts of perpetuity. Might April 16^th signify a new day for making sense of healthcare directives? Perhaps this sense and sensibility inspires each of us to be more reasonable and responsible in personal matters of life and death.