A 30-year-old patient with COVID-19 who was on a ventilator passed away last week. He hadn’t laid out his end-of-life wishes (referred to as advance directives). After seeing the numbers related to his son’s condition, his father was devastated and felt that further treatment was only painfully prolonging the inevitable. His mother wanted to try everything possible to save him. If the patient himself was able to speak, he could have expressed what his wishes were and saved his family from this heart-breaking conflict.
But he hadn’t planned to die.
This tragic situation is too common as families often fail to discuss emergencies and end-of-life wishes ahead of time. It’s even more stressful to make this kind of decision when the stakes are high, as they often are now amid the coronavirus pandemic. This is why it’s so important to learn about and make end-of-life treatment choices before a crisis occurs. None of us want to imagine the worst, but the worst is a callous reality.
On a COVID-19 unit in metro Detroit under the care of Dr. Asha Shajahan, only 1 of 55 patients had an advance care planning document. Dr. Shajahan writes about that patient as well as other patients on her unit,
“That patient was nonverbal after having a stroke at the age of 54. I phoned his sister, his designated legal guardian, and she read his advance care plan to me. “Doctor, tell him I love him,” she said. It was comforting to know that this patient had a designated advocate.
“When I asked another patient about her advance directive, she laughed nervously and asked, “Is this a bad omen?” She was on four liters of oxygen, breathing heavily, but stable. She thought the conversation was taking place because she wasn’t going to make it.
“Another gentleman told me, “I’m 62 years old and I have a lot more living to do!” His eyes were glassed over from his high fever and his hands clutched his chest as he tried not to cough. He was afraid that his age would prevent him from obtaining lifesaving measures, especially as some have suggested that older people are less worthy of being saved or even should be willing to die to preserve the American economy.”
Dr. Shajahan has spoken to many of her patients about advance directives, asking questions such as “Do you want to be resuscitated including being on a ventilator, having electric shock applied to your chest and chest compressions that can break your ribs? Would you want a feeding tube? If you were unable to make medical decisions, who do you want to make those decisions for you?”
There are difficult questions to answer, but they are especially difficult for someone who is already sick and terrified in a lonely hospital bed.
One woman who was also fighting COVID-19 from home herself was faced with decisions for her brother’s care as he didn’t have advance directives in place and was on a ventilator. “I don’t know what he would want,” she said, “making this decision for him is too stressful.” To say it’s an overwhelming situation is an understatement.
Too often, the conversation between doctors and patients about advance directives is saved for Medicare wellness visits at the age of 65. A review of studies from 2011 to 2016, conducted by researchers at the University of Pennsylvania, found that only about one-third of American adults had advance directives.
But this is a talk everyone should have, even before the magic age of 65. Dr. Shajahan’s COVID-19 unit has patients from age 18 to 103.
Now is the time to decide on your end of life plan, discuss it with loved ones, write it down, and have it available to discuss with a doctor. An estate planning lawyer can help you learn how to make your wishes legally sound in case of any dispute between family members so that there will be a clear path forward.
We all have the power to know our family’s wishes now and can avoid guilt-ridden thoughts of “I wish I knew what he would’ve wanted.” Talking about death is horribly uncomfortable, but perhaps this pandemic is the harsh nudge we need. Discussing advance directives ahead of time will most certainly save a lot of emotional pain and help to lessen the fears regarding death.
“If you won’t do it for you, do it for your family,” Dr. Shajahan says. “It will lessen their burden when and if, God forbid, you fall sick.”
For help with your advance directive and other estate planning documents, contact us at Wilson and Wilson Estate Planning and Elder Law, LLC at 708 482 7090 for our main office in LaGrange, Illinois or at 847 656 8958 for our Northbrook, Illinois office.