People die naturally. But everyone wants to walk peacefully and beautifully. No one wants to suffer before leaving. For example, he has various tubes inserted all over his body, lives on machines, and is forced to accept chest compressions and other rescue.
It would be a comforting thing if one could still have a good grasp of one’s rights at the last moment of one’s life and choose to die with dignity and no pain.
Dr. Clove would like to introduce the concepts of [living wills] and [palliative care], hoping to help those in need.
What is palliative care?
Palliative care originated in the 1960s. It does not aim at curing diseases, but focuses on improving the quality of life of those patients whose lives are threatened by diseases and helping them face the difficulties and problems of this period together with their relatives and friends.
In short, palliative care has two purposes:
Closely connected with palliative care is hospice care, especially for patients whose expected life is not more than six months, through various means such as medicine, nursing, psychology, nutrition, religion and social support, they can die as comfortably, with dignity, preparation and peace as possible in the last time of life.
Palliative care is neither not to treat nor to give up, but to face the disease with patients and their families in another way.
What was a living wills?
An important part of palliative care is to promote the signing of living wills. Living wills are written documents, which are written documents proving people’s wishes and choices in the face of inevitable death. The main contents include two aspects: whether to help you or not and who to help you.
1. [Do you want it or not]: Living wills, specifying whether you want it or not
It mainly lists whether it is necessary to use some rescue measures or medical methods when the disease cannot be cured or dying. The common ones are:
(1) Cardiopulmonary resuscitation
Cardiac resuscitation refers to a medical method in which medical personnel help restore the heartbeat through chest compressions when the heartbeat stops.
Although chest compressions may help restore the heartbeat, they cannot cure the disease itself and the heart is likely to stop beating again.
Repeated chest compressions only delay the process of death, not really save the patient, and cannot make the patient recover. In addition, chest compressions may itself cause more physical injuries such as rib fractures and organ bleeding.
(2) Tracheal intubation
Tracheal intubation refers to the medical staff who can’t breathe by themselves by cutting an incision in the trachea and assisting breathing through mechanical equipment such as ventilators.
Similarly, the use of ventilators cannot cure diseases, but only prolong life in a short period of time.
Because it is a minor operation, there is a certain risk of bleeding and infection. The patient cannot speak after tracheotomy. Sputum suction and other operations may also cause discomfort to patients.
(3) Gastric tube
Patients cannot eat by themselves. For example, when they are in a coma, medical staff can maintain their lives by placing nasal feeding tubes or performing manual feeding such as percutaneous gastrostomy.
The nasal feeding tube requires a thin tube to be inserted through the nose.
(4) More other medical methods
In addition to the above three main contents, it also includes other treatments, such as using booster drugs to maintain blood pressure when blood pressure drops, central venous intubation, hemodialysis therapy, intravenous nutrition, etc.
(5) Need for how services
In addition to [not] what, you can also request [not] what medical services, such as: various nursing services that fully relieve pain, relieve physical discomfort symptoms, make the body as comfortable as possible, psychological, emotional and religious support, and even ask who cannot visit and who can accompany you in the last time.
2. [Who Helps You]: Appoint Your [Health Agent]
Another important content is the appointment of a [health agent]. This [health agent] is responsible for making decisions and choices instead of the patient when he is seriously ill and unconscious and cannot make medical decisions by himself.
This person can be a relative, friend, neighbor or anyone of the patient, but he must be a person fully trusted by the patient. He has had sufficient communication on the serious illness and dying problems before, and he knows the real wishes of the patient.
When something unexpected suddenly happens, Or when there is a situation not listed in the [living wills], he can communicate with the medical staff on behalf of the wishes of the patient and make the most favorable decisions and choices for the patient that are most in line with the wishes of the patient, rather than the wishes of himself or others. Now many hospitals in China already have similar forms for hospitalized patients to appoint health agents.
How to implement it?
1. Prior decision
It is better not to wait for the crisis to appear before discussing and signing [living wills], but to sign [in advance] when the health condition is better and there is no mental problem.
The best place is not in the emergency room or intensive care unit of the hospital, but in the living room or other familiar place. Only in this way can full discussions be held and wise decisions be made.
2. Fully informed
[Living wills] is an important legal document based on patients’ right to informed consent and independent decision. Only when they are fully [informed] can they make truly rational, true and independent decisions.
So, before making a decision, It is important to fully communicate with professionals in this field, It is better to be a doctor who is familiar with the patient’s situation or a social worker from a relevant institution. Not only do you know the contents of living wills, but also you can give professional explanations to various rescue measures and medical care contents mentioned therein, and you can clearly know that various choices will lead to what consequences, etc.
3. True will
It is very natural and necessary to make any important decision, especially the [living wills] related to the final stage of life, to discuss with family and friends and listen to their opinions and suggestions.
But remember, this is a decision about [you], not others, in the final stage of your life. This should be your real will and should not accommodate the thoughts of others, such as your partner or children.
Moreover, one should clearly tell one’s wishes to the family members who accompany one in the final stage, so as to avoid possible confusion, different opinions and even disputes in the future.
4. Sign a backup and carry it when admitted to hospital.
In China, there is no similar bill, [Living Wills] are not legal documents either. However, [Living Wills] documents can still be prepared in advance. A number of backups, one to the designated health agent, one to relatives and one to keep, will be carried with you when you are seriously ill and admitted to hospital and handed over to the competent doctor, so that everyone can understand the patient’s real wishes on this problem and better serve him.
The Beijing Living Wills Promotion Association (www.xzyzy.com), based on the above contents and referring to the form of the United States, has made a form-based living wills document of < < My Five Wishes > >, which is very clear, clear and practical. You can download, fill in and print this form on the website of the Association.
It should be pointed out in particular that illness and death are complicated matters, and decisions on serious illness and dying state cannot be clearly considered at once. Patients have the right to change past decisions at any time, re-sign [living wills] documents, and make new choices and decisions.