We are all mortal. However, it is not easy to think about our own demise, or perhaps even to comprehend it. When we are young we look to the future and its opportunities and challenges. Later, as we age, we perhaps more frequently allow our minds to stray to issues of death and dying, if only reluctantly.
My work as your physician largely focuses on keeping you healthy and treating those conditions that arise that might impair your health. In general, with the wondrous investigative and therapeutic tools that have come to our service in the past two decades, we do that job effectively. Plus, the human body is quite well made and often does just fine without much medical intervention.
But age takes its toll and what I have sometimes called the “asterisks of life” occur. Everything is fine and then, suddenly, it isn’t. Serious illness can not only occur unexpectedly, but quickly.
In those situations where the patient is gravely ill and not able to speak for himself or herself, whether by accident or sudden severe illness, it is critical that Dr. Isselbacher and I know whom you want to speak for you.
Often the doctors’ choices about what to do for you in a grave situation are cut and dried. Certain things we must do, and other times we equally know certain things we cannot or should not do. However, there may well be a gray zone in the middle where choices about types and intensity of treatment with different ramifications and opportunities for improvement may be quite difficult and should involve the patient.
That is the importance of your identifying a health care agent who can speak for you, should you not be capable of speaking for yourself, to enable us to deal with such difficult situations that profoundly affect you.
In Massachusetts (and in most states, I believe), the spouse is automatically the health care agent for the patient. In other circumstances (divorced, never married, widowed), you need to appoint an agent by legally assigning to that person your health care proxy—the right to make medical decisions on your behalf when you cannot.
Please begin to consider whom you want to be your health care agent. Also, have a discussion (or at least think about having a discussion) with that person as to what your wishes would be in a sudden, dire situation where you are in an ICU and your survival is threatened. Beginning the discussion when you might soon become incapacitated is too late.
These discussions are difficult because you really have to talk through the gray areas when required interventions are severe (surgery, intubation, prolonged ICU care), full recovery may not be possible or likely, and prolonged debilitated states are in the picture. You will receive more guidance on this discussion soon with a discussion of “living wills” in a future post.
Attached is a standard Massachusetts form for your use (Mass Health Care Proxy). It is quite straightforward. Please download it, think about it, and get it filled out, signed and witnessed. It does not need to be notarized. Give us a copy by paper or electronically. We will keep it with your medical records.
We all need a health care agent to be sure a loved one will look after our interests. Please get this on your agenda. Dr. Isselbacher and I and our staff will be happy to further advise you on details. We are all more secure, you most of all, when the path for medical decisions about your welfare is clear to all.