Dr. Peter Rutherford
The last two decades have seen a tremendous increase in the sophistication and complexity of available health care. We enjoy increased knowledge, new and improved technology, enhanced clinical skills of physicians, nurses and therapists, and superior medications. Until a couple of decades ago many health conditions had limited or no effective treatments, and an individual’s life ended naturally and hopefully peacefully. Today, in some situations health care has the ability to prolong life but often with a poorer quality of life both in the short and long term. As individuals we must all consider this when we make our medical care decisions, and make sure that our own personal values guide those decisions. How do we do that?
No matter what our age, we need to think about and define what our goals are individually for our lives. Are there actions or things that we want to accomplish before we die? What are the baseline or minimum things we want for quality of life? What degree of independence in our daily activities is required for happiness in all our lives? By answering these questions, we are better prepared should we develop a life-limiting health condition. In that case, we (or someone we trust should we no longer be able to make those decisions) can compare the diagnosis, treatment options, and prognosis against our original wishes. This also ensures that the amount and type of treatment received is what we want — not too much, not too little.
There is a common misconception that “not doing everything,” is “giving up,” is “quitting,” is “not caring.” This is absolutely not true. “Doing everything” increases complexity and increases risks for less comfort. While “doing everything” may or may not extend life, it certainly can result in a lower quality of life from that time forward. In some situations the “caring” thing to do is accept the inevitability of death and look for the care that will give the highest level of comfort and quality for our remaining time, surrounded by those individuals we want, those we love and care about.
This thinking is not quick and easy. It is complex. Many people want help in doing this thinking. There are physicians/staff at all local hospitals and clinics who are being trained in facilitating this process of decision making. There is an Advanced Care Planning Workshop program provided without charge to all members of the community on the third Tuesday of every month from noon to 1:30 p.m., at the Confluence Health Sleep Center Conference Room on Miller Street in Wenatchee. This facilitation and workshop is based on the learnings of the Gunderson Lutheran Healthcare organization in LaCrosse, Wisconsin. Here in Washington a statewide collaborative has been formed, “Honoring Choices PNW” (Pacific Northwest), funded by the Washington State Medical Society, the Washington State Hospital Association, several insurance companies, many hospitals and clinics and other philanthropic organizations It means to ensure that the facilitation of training physicians, medical staff and community members is thorough and standardized. If you want to read more on this topic, an excellent book I have read and highly recommend is titled “Being Mortal,” by Dr. Atul Gwande.
Re-evaluation of this thought process is most appropriate and really required as we move through our lives. Social situations, family dynamics, and individual life goals change. Doing this kind of reflection, though, before the health crisis, gives the most thoughtful decisions.
Lastly, but very importantly, it is crucial that whatever individual decisions you make, they should be communicated and documented. Talk to your spouse, your children, your parents, and your physician, both verbally and in writing. Your attorney can help with documents, but it is not necessary. You can use standardized documents available at hospitals and clinics, and sign them in the presence of a notary. Communication is the key.
We owe this health care goal setting and decision making not only to ourselves, but our loved ones. At a time of crisis, someone has to make the decisions. You owe it to yourself to be that person.
Peter Rutherford is a physician and CEO of Confluence Health.