Wednesday, November 5, 2008

Mayfield on End Of Life Decisions

Dr. Douglas Mayfield, an anesthesiologist, has submitted the following guest blog post on end-of-life decision making. If you wish for your individual rights be respected by the legal system, you may find his advice helpful:
I am an anesthesiologist. I give anesthetics so that patients will be unaware during painful procedures. Recently, I encountered the following cases.

A 102 year old woman who is comatose and requires a machine to breathe for her. Her heart, kidneys, and liver are failing. Her son, 77, demands that we ‘do everything’ to keep his mother alive.

Because her heart rate is less than 40, a cardiologist will put in a pacemaker to make her heart to beat faster. I will give drugs to combat any deterioration in her vital signs.

A 94 year old man who requires care 24/7 and cannot eat or speak. If you simply step to his bed side, he cowers and screams in fear and will not stop until you leave.

Because a tube to his stomach (bypassing chewing and swallowing) is plugged, a gastroenterologist will replace it. His family has given consent. I will give small doses of medication to block his awareness of the procedure.

Whatever your beliefs, you know that your life will end. As human beings living and enjoying life, we don’t dwell on death, but it will come. When it does, do you want to be in a situation like those above?

Once I can no longer think, I don’t wish to be kept alive. What your beliefs might be, I don’t know, but I suggest you think about it and take steps to give your decisions the force of law.

Don’t force your loved ones, who care about you, to decide what will happen when your health deteriorates.

What steps do I suggest you take?

1) Create a living will. Leave copies with a family member or a legal advisor, as well in a safe place of your own.

2) Purchase a long term care policy. For mine, I pay $1800 per year. It can yield $4000 per month if I am unable to care for myself. The rate is low because I cannot receive benefits for several years and because I bought the policy years ago. If you want more information, you might discuss long term care with a medical professional whom you trust.

Regarding your living will, be specific. Under what circumstances do you not want to be kept alive? Perhaps you wish no extraordinary steps to be taken. But whatever you believe, make your own decision now.

Why do I mention a long term care policy? Because the cost of caring for the patients above, and for thousands, perhaps millions, of people like them all across this country, is paid by Medicare or other government programs.

I encounter such cases often and I don’t want the end of my life to be paid for by other people’s hard earned money. If you don’t want this, or something similar, to happen to you, take reasonable steps now to make sure that it does not.
If you have any comments or question, you can reach Dr. Mayfield directly at: