@BradleyFlansbau, Brad Flansbaum, over at The Hospital Leader offers thoughtful comments about the ambiguities in near-death situations in hospitals. He points out the inherent flaw with advance directives:
You realize that even with the indecision of how our country will manage end of life care and the calls for greater engagement from our citizenry, no piece of paper will resolve certain impasses.
I will offer the following:
Advance directives simply promise more control over future care than is possible. We also cannot predict our preferences as our health states evolve and possibly worsen.
So true, and Brad's article is an excellent exposition on the topic, presenting two "bookend" cases on the matter.
But, let's recall the work of Bernard J. Hammes, director of Medical Humanities and Respecting Choices at Gundersen Lutheran Health System, who edited the book, Having Your Own Say. In my review of the book, I said:
If I were to simplify the theme of the book, it is that advanced directives (ADs) are insufficient when it comes to end-of-life planning. Drawing on the experience of the GLHS and other places, the book demonstrates the importance of an ongoing process for advance care planning (ACP).
So, while nothing can undo the conclusions reached by Brad, the insight offered by Hammes is that we can at least do better in keeping our end-of-life wishes as up to date as possible.
Nonetheless, as Brad notes:
No advance planning can prevent a Mr. Brown or Dr. DeBakey from presenting to your hospital. We can only write about their (and our) plights to provide comfort for the times we look in the mirror for solutions. When the rulebook has no remedy and the right path seems more like the roll of a dice than an ordered prescription, we hope for the best and absorb whatever lessons these unfamiliar cases can teach us.
This kind of intellectual and emotional modesty is, in my mind, the sign of a great doctor. In contrast, s/he who is overly confident in these matters is delusional and empathetically deficient.
You realize that even with the indecision of how our country will manage end of life care and the calls for greater engagement from our citizenry, no piece of paper will resolve certain impasses.
I will offer the following:
Advance directives simply promise more control over future care than is possible. We also cannot predict our preferences as our health states evolve and possibly worsen.
So true, and Brad's article is an excellent exposition on the topic, presenting two "bookend" cases on the matter.
But, let's recall the work of Bernard J. Hammes, director of Medical Humanities and Respecting Choices at Gundersen Lutheran Health System, who edited the book, Having Your Own Say. In my review of the book, I said:
If I were to simplify the theme of the book, it is that advanced directives (ADs) are insufficient when it comes to end-of-life planning. Drawing on the experience of the GLHS and other places, the book demonstrates the importance of an ongoing process for advance care planning (ACP).
So, while nothing can undo the conclusions reached by Brad, the insight offered by Hammes is that we can at least do better in keeping our end-of-life wishes as up to date as possible.
Nonetheless, as Brad notes:
No advance planning can prevent a Mr. Brown or Dr. DeBakey from presenting to your hospital. We can only write about their (and our) plights to provide comfort for the times we look in the mirror for solutions. When the rulebook has no remedy and the right path seems more like the roll of a dice than an ordered prescription, we hope for the best and absorb whatever lessons these unfamiliar cases can teach us.
This kind of intellectual and emotional modesty is, in my mind, the sign of a great doctor. In contrast, s/he who is overly confident in these matters is delusional and empathetically deficient.
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