What is an End of Life Directive?
Texas uses two terms for the document used to describe end of life decisions making. It is called an Advance Directive or Physician’s Directive. It is a statutory form meaning our Legislature created a basic form that can be modified, but the core form must remain.
Few people think we have a good form or tool for decision making. Any form the Legislature approves is created by negotiation and sometimes the various parties to a negotiation have to settle for those parts of an issue that can be agreed upon leaving the “best” or “worst” parts out. The statute with the form follows this article. Physicians Directive
What must be understood is that neither this form nor the Health Care Power of Attorney are considered while a patient is mentally competent. Only once a doctor writes into a patient’s medical record that the patient is not mentally competent to make a medical decision are the two documents relevant. Most people appoint the person who they want to make decisions in the Health Care Power of Attorney. Any number of people can be listed sequentially.
There are two basic decisions. What is done in the event of a terminal illness? And what is to be done in the event of an irreversible condition. These are defined in the statute and explained in the form. To simplify, a terminal illness is any injury or illness that will cause a patient’s death during the next six months no matter what a doctor does to keep the patient alive. Obviously, this is an estimation, or a guess based on the doctor’s experience and statistical data. Most doctors are very unwilling to tell a patient that he or she cannot be cured. This definition is the same standard used to qualify a patient for hospice.
An irreversible illness is any injury or illness that could cause a patient’s death but use of medical care can keep a patient alive indefinitely. However, the patient is never again expected to be able to make his or her own care decisions again – ever.
Very few people like the basic form so I have developed a number of modifications to the form to give the decision maker better understanding of what is desired and/or to grant more room to the decision maker. I also have found several attachments to help my clients consider possible care decisions to discuss with the persons who will be given this horrible task. Each of us should give at least an hour or more to discuss our values regarding various types of issues to be considered in making an end of life decision with those persons who are to be given the task. Some of the factors that should be considered is what effect does pain, lack of mobility, lack of mental capacity, the place where care must occur, the cost of care and any other factor you hold important have on the decision to continue attempts at being cured.
The very first criteria you should consider is do you trust the person to make a decision based on the values you hold as to what is a life worth living. The second criteria should be whether that person is strong enough to allow you to die by instructing the medical staff to stop providing curative care. The persons we choose are almost always those persons who love us the most. This is one of the most heart wrenching decisions we can ask anyone to make. We owe our decision makers as much help as to how and when decisions should be made. We should take as much of the emotional burden from their shoulders as we are able to do. If you have questions please call or email me for an appointment using the information below.