Advance Care Planning Day is April 16th every year. It’s a day to find out more about what we each need to do to make sure our family and/or friends know what our wishes would be if we couldn’t speak for ourselves.
This is not just a scenario when someone is older or has dementia. This could be if someone had an traffic accident and became unconscious. We each should make sure there is someone in our lives who could speak for us.
Resources about Advance Care Planning can be found on the Government of BC website and the Fraser Health website.
Facebook Live-stream on Advance Care Planning
RESOURCE - DEFINITIONS
Advance Care Planning Terms
a way to think about, and talk about, how you would make health care decisions. When done well, it clearly shows your ideas so that others can make the decisions you would have made if you could do it yourself.
your plan to be used by someone else and the medical team if you cannot do it yourself.
a legal document that tells the health care provider what you do or do not consent to. It is used when you can’t speak for yourself and is only for health care conditions and treatments that are named in it and that you have discussed with your doctor, nothing else.
A person 19 years or older named by you to make health care treatment decisions for you when you can’t decide for yourself.
A document that has the name of the person who will make your health care and other decisions when you can’t.
A doctor’s order that says which treatments you do not consent to if you can’t speak for yourself. It may be about CPR, breathing help, blood transfusions and other treatments. It is filled out only after your advance care planning choices have been made and you or your decision maker knows the risks and benefits of the treatments.
RESOURCE - DEFINITIONS
What Can Happen During or After Certain Medical Treatments
Medical treatments have become very sophisticated and invasive over the last few decades. In sudden, reversible health conditions they save lives. When a person is closer to their natural end of life from multiple chronic diseases, frailty or other incurable conditions, the treatments however can provide progressively less benefit and more risks and burdens.
Please contact your doctor or medical team for more information or to answer questions that may have come up.
- CPR is a process of attempting to restart a heart in cardiac arrest (a heart stoppage). It involves fast and deep chest compressions, possibly electrical shocks with a defibrillation machine and placing a breathing tube into the airway to support breathing.
- 95% of cardiac arrests are due to natural aging and incurable disease. These hearts often don’t respond to CPR, or may respond just temporarily.
- In medical TV shows 75 of 100 patients who go into cardiac arrest survive by receiving CPR
- In real life, about 17 of 100 people who get CPR in hospital survive. Of these, fifteen will have varying levels of brain damage, leaving them dependent on daily care. Only about 2 will go home with a clear mind.
- CPR, especially for older people, often causes damage like broken ribs, punctured lung or liver, bruising and more…
- People most likely to do well with CPR are those with little or no underlying health conditions and the challenge to their heart is temporary and reversible like a sudden asthma attack, drug overdose or simple myocardial infarction (blocked artery supplying the heart muscle).
- If a person is at his/her natural end of life from incurable longstanding disease, they are unlikely to survive to make it out of hospital after receiving CPR, and many don’t survive the CPR attempt.
- If a person has not made arrangements to decline CPR, the medical team will perform it. The family will be directed to leave the room during resuscitation efforts. This means the family will not be present when their loved one dies.
- The equipment in the intensive care unit (ICU) generally takes over the essential body functions while an individual is healing from a very severe illness or accident. In particular, patients who need to have their breathing supported by machine (called a ventilator) will be placed in an ICU.
- For short term illnesses or accidents, a ventilator can be lifesaving. However, when there is terminal illness or extreme frailty prior to admission to the ICU, the complications and risks are predictable and progressive. It has been described that ICU care in these patients is ‘futile’. Where patients have irreversible disease and can never be cured, the ICU does not prolong life but actually prolongs dying.
- If a person is on a breathing machine (respirator or ventilator) they will
- not be able to eat or talk
- be given medicine that keeps them aware but unable to move, which could be frightening
- potentially have discomfort (from the machine) that may require medication treatment / relief
- Most ICU patients who are there with underlying chronic diseases and stay for weeks or longer suffer from thinking, emotional, or physical disabilities. As a result, they will need help with basic activities of daily living such as feeding and toileting. They will also likely have reduced quality of life should they actually survive to be discharged from hospital.
- 75% of patients who have had a lengthy stay in ICU will survive no more than a year.
- Dialysis is a treatment that can treat the sudden loss of kidney function, or the later stage of progressive chronic kidney disease.
- It does not heal kidneys; it works by artificially doing about 15% of the job kidneys do to remove waste from the blood and extra water from the body.
- There are two types of dialysis: in hemodialysis blood is withdrawn from the body by a machine and passed through the machine to be cleaned.
- In the other type, peritoneal dialysis, a person always has dialysis fluid in their peritoneal (abdominal) cavity so the blood is constantly being cleaned. This fluid must be changed several times a day by the individual through a special portal that is created in their abdomen by the a surgeon. Only certain individuals, with good mental competency and the ability to take care of their sophisticated medical needs, are good candidates for peritoneal dialysis.
- In the elderly, starting dialysis often leads to a sudden loss of independence, increased falls, and decrease in mental functioning. Younger able-bodied people who start dialysis often have to quit work because of extreme fatigue and the time required for 4-hour treatments, 3 days a week. Dialysis increases the life span of people over age 80 an average of 8 months.
- A feeding tube is a medical device used to provide nutrition to patients who cannot eat by mouth, are unable to swallow safely, or need nutritional supplementation.
- Placement may be temporary for the treatment of acute conditions or lifelong in the case of chronic disabilities. There are a number of ways the tube feedings can occur, either into the stomach or various parts of the intestines. The two most common are nasogastric tube where a tube is threaded through the nose into the stomach, or percutaneous tube feed. The latter type pierces the abdominal wall into the stomach or intestine and bypasses the throat completely.
- Being fed by a tube doesn’t necessarily take away the feeling of being hungry and may cause nausea.
- If a person is confused while being tube fed, they may need to be physically restrained or medicated to prevent them from removing the tube. The use of restrains increases the risk of bedsores.
- If someone can’t swallow as a result of end-stage dementia, tube feeding will not increase their survival or quality of life. Tube feeds do not prevent the contents of the stomach from backwashing up the esophagus and going down the airway into the lungs, which can cause aspiration pneumonia.
- 70% of North Americans die in hospital although most say they want to die at home
- Critically ill patients say their priorities are to
- not suffer
- be with family
- be able to touch others
- be mentally aware and
- not be a burden to others.
- Unfortunately, the closer a person is to end of life, invasive medical technologies often cannot meet these needs. Even simple treatments like providing intravenous fluids (IVs) and antibiotics may do more harm than good when it comes to quality of life.
- More than 90% of physicians say that if THEY were unconscious and unlikely to recover, they would want only good pain and symptom control and not life-prolonging treatments, even if this meant their life could be shortened.