When drafting ADHCs for our clients we introduce them to four treatment philosophies that are well understood by medical professionals:
Active Treatment: This category of care includes all reasonable medical attempts to extend life. This would include resuscitation, intubation, surgery, dialysis, feeding tube, antibiotics, and other interventions.
Treatment without Resuscitation: Same as above but without allowing resuscitation.
Trial Treatment for 30 Days: Active treatment for 30 days. After 30 days, if there is no improvement or increased hope for improvement, treatment is changed to comfort care only.
Comfort Care: Treatment to relieve symptoms and improved quality of life including pain medication. No treatment done solely for the purpose of extending life.
We then ask them to say which treatment philosophy they would want their agent to use in the following examples:
Condition 1: Permanent Unconscious Condition
An incurable and irreversible condition with no reasonable possibility of recovery from a vegetative state. It involves the complete destruction of the higher structures of the brain, but not the brain stem. People in PVS can breathe. Heartbeat, lung function, and other biological functions continue. They can appear awake. They cannot communicate, make voluntary motion, and are not meaningfully aware of the world around them. They require a feeding tube to survive.
Condition 2: Coma
A state of profound unconsciousness in which an individual is incapable of sensing or responding to external stimuli.
Condition 3: Terminal Condition with Unmanageable Pain
An incurable and irreversible condition caused by injury, disease, or illness, that would within reasonable medical judgment cause death within a reasonable period of time, usually six months, in accordance with accepted medical standards, and where the application of life-sustaining treatment would serve only to prolong the process of dying and where pain cannot be adequately managed without rendering patient unconscious.
Condition 4: Advanced Dementia Neurological Damage or Alzheimer’s
An incurable and irreversible condition caused by injury, disease, or age that destroys memory and impulse control. Advance stage is marked by major personality changes and an inability to recognize family or friends.
We also ask them if there are any other conditions or symptoms they would want addressed. Many clients have professional experiences or experiences with family members that have led them to have strong preferences about certain types of treatment and these can always be added.
While the situations above will not cover every medical emergency that might require an agent to make choices they give a good guide to allow them to at least think my analogy and provide guidance for many more questions than the just feeding tube or no feeding tube kind of question in the hospital forms.
If you would be interested in creating a detailed advanced health care directive for yourself, contact us to schedule a free 1/2 hour consultation at (206) 459-1908 or email us at firstname.lastname@example.org.