Advance Directives: Fill & Download for Free

Simple DeathNo breathing, pulse not palpable, dilated pupils, not reacting to light – these are the 3 cardinal signs that we check before we declare that everything is over. It used to be that simple. But not anymore.But now, times have changed.‘Complex’ deathToday a patient on pacemaker, the heart continues to beat, on ventilator the breathing continues.In addition, ionotropic drugs make the heart muscle work harder, antibiotics ward off microbes to prevent infections, air-beds delay bed sores, dialysis stand-by if kidneys fail; making dying even more difficult, not just for the patient or their families, but for the doctor as well.So checking for breathing, and pulse for heart beat became pointless for such patients.That’s when we try to see if there is evidence of brain death. Tests like an EEG, caloric tests and dolls eye test tells us if the brain has some leftover function or not. Once brain death is confirmed, then we try to think if there is a chance and background of organ donation and if the family is likely to consider it. Most of us know our regular patient’s family very well. Once brain death is confirmed, the family is apprised and life support is weaned off (if organ donation is not planned).For most people, who die as result of a progressive natural illness, the doctor decides (in consultation with the family) not to put the patient on life-support system; after signing a legal document called DNR (Do not resuscitate).One way of avoiding ‘Complex’ death is to give an advance directive (AD) confirming that you yourself want not to be resuscitated (DNR).In many cases it would save your money and our time.I have given advanced directive for DNR myself, not that I wish to die, but I refuse to live connected to tubes and wires with aliens in green masks waiting for the ECG blip to stop.

Of course I don’t know the details of John McCain’s glioblastoma multiforme but I’ve treated my fair share of patients. Typically there is a brief remission after debulking surgery where some but not all of the cancer is removed, followed by brain radiation therapy and the oral chemotherapy pill Temodar. Probably a course of Avastin, an IV angiogenesis inhibitor is added at sometime.Invariably the cancer returns and causes major neurological dysfunction. That could include inability to walk, inability to think clearly and difficulties with speaking.At some point in time, the treatments become futile and/or a patient’s quality of life decline to a point not worth continuing.For everyone, that point is different so I’ll advocate that all of us complete an Advanced Directive, a legal document setting out what each of us wants done for us if we become unable to make the hard decisions about continuing or discontinuing therapy.The large majority of us don’t want our life prolonged if it’s just a matter of lengthening our time of suffering.John McCain, as a very thoughtful and intelligent individual, would have completed an Advanced Directive and also verbally instructed his wife and children regarding his end of life wishes. He doesn’t strike me as the kind of person to leave things to chance or to put the painful responsibility of making tough decisions at the end of his life in the hands of suffering family members.

Absolutely. It is best to always have an Advance Directive. If you don't have one, it is extremely wise to get one before you go through something risky like heart surgery. This way, if something goes wrong, there will be no confusion about what you want done (health care power of attorney) and people will be able to manage your finances for you (financial power of attorney.)