Let's talk about this....

I watched a movie the other night staring Al Pacino called "You Don't know Jack" In this HBO movie Pacino plays Dr. Kervorkian.

Dr. Kervorkian also known as "Dr. Death" was tried and convicted and sentenced to 10 -25 years in prison. He was released in June 2007 after serving 8 years in prison for his role in patient assisted-suicide. What an interesting man. A man of conviction and willing to put everything on the line to change what he considers an unjust law. He's the kind of man you either admire for his convictions or hate him for his beliefs.

In the state of Michigan where Dr. Kervorkian was practising they didn't have laws which would allow him to participate in patient assisted-suicide. He challenged the law on many occasions. In 1998 he was accused and then convicted — of murder after injecting lethal drugs into Thomas Youk, 52, an Oakland County man suffering from Lou Gehrig’s disease.

Dr. Kervorkian now 81 years old still believes that people have a right to choose when they want to die. He is a advocate for terminally ill patients right to die via physician assisted-suicide.

I listened intently to the movie and then did my own research on Dr. Kervorkian and physician assisted-suicide. I personally don't like the term assisted suicide, to me it immediately implies criminal activity. I don't believe it is and here's why.

Let me play devils advocate for a moment. We already have in place "Advanced Directives" and "No Code" orders. Some of you may argue that Advanced Directives and No Code does not mean that the doctor's assist you in your dying process. Well let's look at that. A No Code order means that if you heart stops or you stop breathing the doctor or health care practitioner is not going to stop that process and they will allow you to die. So how is that any different than saying ok..... you have a terminal illness the medical field has done all it can for you the outcome will ultimately be death....you may die today, tomorrow, next week, next year who knows...but you will die from your disease.

Let's imagine your disease is Lou Gehrig(ALS) or MS or even something like advanced emphysema where you struggle for every breath you take, how long would you fight this battle?

Prior to any of the 130 assisted-suicide Dr. Kervorkian participated in he interviewed the patient and the family to assess their mental well being, he wanted to make sure they understood what it was they were asking him to participate in. He video taped his interviews. From what I could tell all of these people had done everything the medical field had asked them to do and they were just biding their time on this planet before nature took their last breath. These individuals felt that their quality of life was gone.

Now the anti Dr. Kervorkian activists felt he was playing god and feared that by legalizing physician assisted-suicide you were opening the door to the possibility of doing away with people prematurely.

On a personal note I can remember when my mom was caring for her dying husband at home and I asked her about his pain, or what he wanted with regards to death. He had extremely advanced cancer had undergone chemo, radiation, surgeries you name it. He had led a full life and he knew his time was coming. The doctor overseeing his care had written him a prescription for a liquid morphine. My mom told me she asked the doctor how much she should give him, the doctor's response to my mom was pour him a tumbler full leave it at his bedside he will take what he wants...and so that is what she did. He drifted off to sleep, only to wake briefly the morning of their anniversary to say his good-byes and he was gone. So you tell me....did the doctor assist with his dying process?

This is definite food for thought....what do you think?

Talking about what matters and what you want......

Back in 2008 I made a post about "Advance Directives". In that post I talked about the importance of planning for what you would want done if you were given a terminal diagnosis.

In that post I mentioned that our Health Authority had put out a series of pamphlets entitled "Advanced Health Care Planning" They were a series of 4 pamphlets. The first pamphlet Planning Fact sheet; is used as a tool to help the individual plan for advanced care and talking to the family and health care provider about their wishes. The second pamphlet dealt with CPR and what that means and the benefits and risks. The third asks you to look at how much health care you want. It describes 4 different levels of care, Comfort, Limited, Surgical or Intensive Care. The final pamphlets talks about feeding and for some that can be one of the most difficult topics to discuss. In light of what is currently going on in my family it seemed like an apporiate subject to talk about again.

The other day when my mother and father in law returned home from their trip to the cancer agency they discussed with us what the oncologist had to say. One of the topics MIL mentioned was "Palliative care". When I heard her speak those words I thought, thank god someone had the wisdom and foresight to brooch this sensitive topic with them.

I was a palliative care nurse for 5 years. I was so please to hear that MIL was open to all the program had to offer.

Palliative programs help not only the patient, but they help the families deal with end of life issues and how to help the individual deal with medical or emotional issues that they may be faced with during their journey.

One such issue that my MIL might be faced with is that of oxygenation. With the cancer being in her lung she will come to the point when taking a simple breath will become a struggle. In order to help minimize this discomfort she will be entitled to receive home oxygen and oxygen therapy at no cost to her or the family. The Palliative care program picks up the cost.

For someone who has to deal with knowing their time is limited, the last thing they need to worry about is the financial implications of receiving such treatments. Knowing that things such as this will be taken care of provides a certain peace of mind and can allow the individual to focus on what truly matters to them at this point in time.

Palliative programs provide such a valuable service to the community. The program is headed by physicians, pharmacist, physio and occupational therapists, registered nurses, pastoral care, and even provides for alternative therapies such as music, pet, therapeutic touch and so much more. This program provides an opportunity for an individual to stay at home for as long as they like and can manage. It also provides an opportunity for respite for the caregiver.

There are so many wonderful services that this program provides, and I am so thankful that we have that available to my mother in law, and that she is receptive to becoming part of the program.

If you would like to learn more about Palliative care programs here are a few links.....

Canadian Hospice and Palliative Care Association
Health Canada
Cancer Research UK what is palliative treatment
The National Hospice and Palliative Care Organization

Advanced Health Care directives.....what would you want? Does your family know?

First, let me thank all of you for your kind words. But as I wrote to a fellow blogger and in my comments on my previous post. I do not have MS. I am investigating it....lots of variable to take into consideration, lots of things to be ruled out. I was just asking any of you who where familiar with the disease if you wouldn't mind sharing what you could. I apologize if I lead you down a wrong path.

On a previous post I did on health care and the possible causes for the "crisis" as we see it, I mentioned that because of the technological advancement being made in health care, we are living longer, and able to save lives, where as before, we were unable.

While I was waiting to see the doctor the other day, I came across some literature he had in his office. They were called Advanced Directives and DNR. He told me that when ever he takes on an elderly patient he presents them with the literature and talks to them about it. I guess planting the seed.

In British Columbia our Health Care delivery is broken down into Regions or better known as Health Authorities. It is these authorities who are ultimately responsible for providing the funding to the hospitals and for public health care. Our Health authority has put out a series of pamphlets entitled "Advanced Health Care Planning". They are a series of 4 pamphlets. Pamphlet one is called a Planning fact sheet. It is to be used as a tool for planning advanced health care and talking about what health care you want in the future if you are unable to make or communicate those decisions for yourself. They say Advanced health care planning is a process of Learning about what health care treatments are available and what they can do for you. Discussing with your family, friends and health care providers what you think about the treatments available. Deciding what health care you want in the future based on your learning and discussing and finally Documenting your decisions in an advance directive(living will)making sure everyone(your family, your doctor, your caregiver) has a copy so when the time comes they can make the decisions you want them to.

Pamphlet 2 talks about CPR what it is, what you need to know about CPR, what are the benefits and what are the risks, Pamphlet 3 asks you to look at how much health care do you want? It describes 4 different levels of care. Comfort care, which means that tests and treatments are done not to prolong life but to maintain comfort. Limited Care, means more treatment than comfort care but less than surgical. That means if you develop a pneumonia you could receive antibiotics, blood tests etc., if you were bleeding you would get blood products...but there would be no surgical intervention. Surgical care means you would get everything under comfort care plus surgical, Intensive care means that everything a modern hospital has to offer. Again, this is something that should be discussed and your loved ones , doctor and health care provider need to know. The Pamphlet 4 talks about feeding, and for some the most difficult. It talks about basic feeding, supplemental feeding, intravenous feeding and tube feeding. The pamphlet reviews dehydration and the bodies natural way of shutting down and preparing for it's next journey, death. Families often have issues with not feeding their loved ones, for some it is very culturally ingrained that their loved one needs to be fed even if they are not alert enough. This then posses harm to the patient.

These are difficult topics to discuss, but very important. If you can talk about these issues for yourself or your loved one, it can save so much heart ache when the time comes. There is nothing more stressful on a family than to try to determine what their loved one would have wanted.

On many many occasions I have been asked by a family members what they should do. My answer to them is what do you think their loved one would want? What was their quality of life before this, had they ever expressed anything about if their heart should stop or if they should stop breathing would they want to be put on a machine. Have they ever mentioned if they couldn't feed themselves did they want to be tube fed? Again, these are very difficult questions to talk about, but let me tell you, when I have had to deal with families where these directives have been discussed, it was so much better for everyone. We could help with the patient passing as comfortably and painlessly as possible, as well as providing support to the family, and explain to them the process of dying. What they are seeing, what they can expect.

I can remember when my sister was passing. She wanted to die at home, but she and her husband had not done anything about a DNR. Had I not been there with them to explain that this was imperative to have, we would have had to call an ambulance and they would have been obligated to do CPR on her. I was able to get my sister into the hospital to see the doctor, discuss the prognosis...which she already knew....two days later she was gone. Peacefully and at home surrounded by loved ones. The way she wanted.

I know this may be difficult , but it is so necessary to discuss this if not for your peace of mind then for those around you.

Most of us are in the sandwich generation, and if your parents haven't discussed their wishes with you be brave and bring it up with them. They most probably want to talk about it anyways but just don't know how.