At 79, Hank had reached life expectancy. Yet, he was being treated for cancer in his liver duct with an experimental immunotherapy medication. He became delirious, with a temperature of 105 degrees, and sought treatment in the ER. His vital signs were stable, but survival was questionable.
The ER physician did a quick assessment of the situation with the intention to “pass judgment and reach a verdict.” Did Hank deserve to live or die? What did Hank want? What did his family want? Who decides?
Hank’s daughter, Jill, claimed to be his medical power of attorney (POA) and moved front and center. Hank’s wife was sitting near his stretcher and listened intensely. There were several family members gathered around. Jill was well aware that there was no cure for Hanks cancer, yet hoped he might live as long as possible. That meant Hank would need IV fluids, antibiotics, and admission to the ICU. There was a real concern that Hank could die in the hospital.
The physician was not eager to pursue aggressive, lifesaving measures with Hank, reminding Jill of his oath to do no harm. Jill had not taken the Hippocratic Oath and seemed to forget that humility is necessary for good leadership. Her voice was overpowering the concerns of others in the emergency room. Was there a better way of handling this life-and-death situation?
Hank was confronting a type of judgement day – would he experience the rewards of heaven through a good death or sentenced to purgatory that occurs in being hospitalized? Hank’s fate was up to Jill.
The judicious proceedings during judgement day can help caregivers understand how humility supports acceptance:
The patient: innocent victim
Judgement day has one purpose: To declare the innocence of loved ones and release them from the harm of cruel and unusual punishment. Patients who have a chronic illness generally suffer long enough. When they take a turn for the worse, they need to be read their medical “Miranda Rights” and be released from custody.
Hank has the right to remain silent. Truly, anything he says can and will be held against him. If he demands more treatment, he becomes a burden. If he doesn’t continue to fight, he betrays his family. Damned if he does. Damned if he doesn’t. Judgement day often creates a no-win situation.
The acceptable solution is for Hank to “plead the Fifth.” He cannot be required to answer any questions on the grounds that it might incriminate him – make him wrong for saying he wants to live or prefers to die. The Fifth Amendment, used in conjunction with healthcare proceedings, might prohibit healthcare providers from abusing their authority, acting like God.
The physician: judge
The emergency physician is the your most impartial judge. He or she is beholden to no one and is open to hearing the arguments from both sides of the family’s concerns. This physician generally has no conflicts of interest and does not function as a personal physician or medical specialist.
In this case, the emergency physician saw nothing wrong with Hank dying – it was more than likely “his time.” His family members were not ready, though, and wanted Hank to fight for his life – prove he loved them enough to keep living. What they said, without saying it, was Hank had not suffered enough. Sadly, “do no harm” was not an option.
Come judgement day, the emergency room “judge” sits on the bench – like sitting on the fence – until the jury of family members reach a verdict. The astute physician understands that he or she has little to do with the fate of a terminal illness. Fate actually decides the time to die, but the medicolegal system allow a patient’s fate to rest in jury of family members.
Family members: jury
People are often afraid of being called for jury duty. Right? Try being selected for a so-called “death panel.” Others are quick to tell the medicolegal system how to operate, yet these same people often shirk their responsibility in sentencing a chronically-ill patient to life or death.
For Hank, the question before the jury was: hospital or hospice? Unfortunately, Hank’s terminal illness was not enough for the family to know that he was dying. They requested more evidence through tests and X-rays to prove beyond a shadow of a doubt that nothing more could be done to save his life. The one-two punch to Hank was the diagnosis of infection and demand for incarceration.
With the findings of sepsis and the belief that all infections are criminal and need punishment, there were appeals for the family to hold out hope for Hank’s turnabout and rehabilitation. The emergency physician felt as helpless as Pontius Pilate, while family members were metaphorically yelling, “Crucify Him!” The physician had to admit Hank to the ICU. Guilty as charged.
Medical POA: the jury foreman
A patient’s last, best hope is a medical POA that shows humility and mercy – qualities of a good leader and caregiver. To the casual observer, dying is wrong. For the family caregiver who acts as the medical POA, dying means your patient might be exonerated and set free.
Jill had not been briefed on the virtue of humility while standing in defense of her father’s life. Hank’s life would be remembered by how it ended and if he got what he deserved. Judgment day is the last chance to “right” Hank’s illness or wrongdoings by acquitting him on all accounts.
A good leader knows when it’s time to lay down arms and surrender, declaring a truce. Humility and quite servitude are fine examples of dignity. The surest way to honor your loved one is to act with humility and nonjudgement. As you render the jury’s choice to convict or acquit, your task is to show leniency and mercy.
Oftentimes, the medical power of attorney is in a precarious position if he or she is not the spouse or primary caregiver. Having the ability to humble yourself will lead to doing no harm. You naturally want the best for your patient and generally that means restoring dignity through freeing him or her from life imprisonment in the healthcare system.
Judgement day often plays out through family members attempting to one up the other by proving their love or moral prowess. This never-ending battle continues until your patient is humbled before you.. The duty of the POA is to represent the virtues of humility and dignity in support of your loved one being free to rest in peace.