The Importance Of Advance Directives

The Importance Of Advance Directives

Posted on Friday, June 7th, 2013 at 9:20 am by Life Matters Media

Stress among patients and their loved ones often stems from disagreements regarding health care decision-making at the end of life, including the choice of when to use or stop use of life-sustaining medical procedures.

Generally, the choices regarding medical care are within a patient’s control. However, it is important to realize that there may come a time when you will not have the ability to make these decisions yourself, due to medical reasons or otherwise.

Most states, including Illinois, have created statutes that authorize you to create a legal document, called an “advanced directive,” to retain some control over your own health care choices, even if you lose decision-making capacity.

There are two basic forms of advanced directives:

  1. Health Care Power of Attorney: This form of advance directive allows you to select a significant other, family member or friend as the decision-maker regarding health care issues should you become unable to make medical decisions. This decision maker, called your “agent,” generally must be at least 18 years of age. A health care power of attorney pertains to health care matters only and allows you to specify in writing the types of care you do and do not want to receive. This specification has the effect of limiting the discretion or powers of your agent regarding those types of care covered in the document. It also gives clear instructions to health care providers about that care. A health care power of attorney takes effect only if you cannot make your own health care decisions. You have the power to change your choices regarding agent or instructions at any time.
  2. Living Will: A living will is more limited than a health care power of attorney. It describes your choices for medical treatment as it applies to end of life wishes. Generally, a living will does not appoint an agent and does not grant discretion for choices independent of those identified in the document. A living will generally takes effect only when you are terminally ill and in need of life-sustaining medical treatment. It states your wishes for the kind of medical care you want should you become unable to state your wishes. Like a health care power of attorney, a living will may be revoked at any time.

Having an advance directive can be extremely beneficial, as it allows you to specify your wishes while easing the decision-making burden on your loved ones. Advance directives can provide clear guidance to health care providers, reduce the likelihood of a dispute with and among family members and ensure you avoid unwanted procedures. It is a very good idea to make sure your doctor (or agent) knows your wishes and has the latest copy of your advance directive on file.

Planning for a time when we might not be capable of making important medical decisions is crucial for each of us. Most hospitals and nursing homes have forms for advance directives available. However, as with all legal documents, it is most advisable to consult with a legal professional to understand your rights and to tailor documents to fit your desires. That way, family members, courts and healthcare providers will have clear guidance as to what care to give and who makes the decision whether to continue or terminate care.

Mr. Goldberg and Mr. Bennington are members of the law firm of Lawrence, Kamin, Saunders & Uhlenhop, L.L.C., Chicago, Illinois, who work in the firm’s litigation and estate planning practices, respectively. This article is not meant to form the basis of any legal advice. The opinions expressed in this article are the individual views of the authors, but not the views of the firm of Lawrence, Kamin, Saunders & Uhlenhop, LLC, it clients, its other members or attorneys.

The benefits of these documents are numerous. By completing an advance directive, you can help avoid potentially destructive disputes, ease decision-making burdens on loved ones and avoid unwanted medical procedures. In addressing the creation of an advanced directive, competent legal counsel should be consulted.


Occupational Stress: Doctors Suffer When Unable To Save Lives

Posted on Thursday, November 29th, 2012 at 1:03 pm by Life Matters Media

Physicians who treat the terminally ill may suffer from emotional stress when unable to save patients’ lives. Burnout and compassion fatigue are two serious forms of occupational stress physicians may suffer, according to research by Michael Kearney, M.D.

Kearney, a palliative care physician at Santa Barbara Cottage Hospital in California, describes burnout as “the end stage of stresses between the individual and the work environment.” Compassion fatigue is “secondary post-traumatic stress disorder, or vicarious traumatization — trauma suffered when someone close to you is suffering.”

Health care journalist Jane Brody addresses the stress and anxiety oncologists struggle with in a new article for The New York Times. Brody writes, “A doctor with compassion fatigue may avoid thoughts and feelings associated with a patient’s misery, become irritable and easily angered, and face physical and emotional distress when reminded of work with the dying.” Compassion fatigue may lead to burnout.

Up to 60 percent of practicing physicians report symptoms of burnout.

According to Brody: “Patients and families may not realize it, but doctors who care for people with incurable illness, and especially the terminally ill, often suffer with their patients. Unable to cope with their own feelings of frustration, failure and helplessness, doctors may react with anger, abruptness and avoidance.”

Physician suicide linked to occupational stress

According to Crystal Phend, senior staff writer for MedPage Today, ”Suicide among physicians appears to follow a different profile than in the general population, with a greater role played by job stress and mental health problems.”

Phend cites a study by Katherine J. Gold, M.D., of the University of Michigan in Ann Arbor, who found that problems with work were three times more likely to have contributed to a physician’s suicide than a nonphysician’s. Mental illness was also 34 percent more common before a suicide among physicians.

Up to 60 percent of practicing physicians report symptoms of burnout

“The results of this study paint a picture of the typical physician suicide victim that is substantially different from that of the nonphysician suicide victim in several important ways,” Gold wrote for General Hospital Psychiatry. ”Inadequate treatment and increased problems related to job stress may be potentially modifiable risk factors to reduce suicidal death among physicians.”

Although physicians have more access to health care, they may be reluctant to seek help. ”I think stigma about mental health is a huge part of the story. There is a belief that physicians should be able to avoid depression or just ‘get over it’ by themselves,” Gold wrote.

More than 200 of the 31,636 suicide victims reported in the National Violent Death Reporting System from 2003 to 2008 were physicians.

Meditation may help physicians

A 2008 study published by the Journal of Palliative Medicine, in which researchers studied 18 oncologists, found that physicians who viewed their work with patients as both biomedical and psychosocial found end of life more satisfying than those with a more biomedical perspective.

“Physicians, who viewed their physician role as encompassing both biomedical and psychosocial aspects of care, reported a clear method of communication about end of life care, and an ability to positively influence patient and family coping with and acceptance of the dying process,” the researchers concluded.

“In contrast, participants who described primarily a biomedical role reported a more distant relationship with the patient, a sense of failure at not being able to alter the course of the disease, and an absence of collegial support.”

Kearney recommends “mindfulness meditation,” a Buddhist-influenced practice for physicians suffering from stress. “The doctor is able to recognize he’s being stressed, and it prevents him from invoking the survival defense mechanisms of fight (‘Let’s do another course of chemotherapy’), flight (‘There’s nothing more I can do for you — I’ll go get the chaplain’) and freeze (the doctor goes blank and does nothing).” He claims that even 8-10 minutes a day of “mindfulness meditation” can help.