As a Palliative Care physician, I can tell you that people often believe that their family understands their wishes only to find out that they do not. Without having an advance care plan in place, families and their sick, loved one often descend into a back and forth argument at the worst possible time.
It doesn’t have to be that way.
I know a healthy 99-year-old woman who began feeling light-headed. She was hospitalized and found to have an electrical problem with her heart that was fixed by the placement of a pacemaker. During her hospital stay she had periods of confusion. She left the hospital and her doctors ordered a home health service. She recovered from this episode well. She has several adult children, living in different states and countries, which requested she consider advance care planning (ACP). It was clear to her family that when she was confused in the hospital, and couldn’t make her own medical decisions, that there were differences of opinions between them as to how she should be treated.
She assumed that the family understood her wishes and would act accordingly. She was firm on wanting to avoid CPR and other types of heroic measures in an attempt to prolong her life at the end. However, some family felt strongly that such measures should be taken. There were other areas of disagreement regarding her healthcare choices as well.
That is where Iris Plans stepped in.
After two sessions of speaking about values, goals, and other areas of importance to the woman, it became clear to most of her family that she would want less aggressive care and to avoid anything that doctors felt would not most certainly benefit her. With continued pushback from one of her sons regarding her an aspect of her care, the Iris facilitator used communication techniques to reconcile the differences. Ultimately the adult children surrounded their mother to support her choices and the care that was consistent with her desires.
A small investment now can have a big payoff later.
Without walking through the Iris Plans ACP process, the woman and her family would very likely never have realized that they didn’t see eye to eye about her care. By investing a bit of time in advance having an important discussion and working through potential areas of disagreement, the woman is much more likely to receive only the treatment she wants, and avoid that which she does not want. Further, with full participation by the family, they have removed the potential for a major family conflict - something which is experienced by so many others during a medical crisis.
With support from Iris Plans, we were able to:
- Define what a good day looks like from the woman’s perspective for all the family to hear
- Issued a “do not hospitalize” request to the family
- Declined the use of skilled nursing facilities, rehabilitation hospitals, or other institutional healthcare residencies
- Laid out preferences for various clinical scenarios
- Completed Illinois Medical Power of Attorney form
- Completed Illinois Directive to Physician form
- Completed Iris Plans’ Disease Specific Advance Directive
- Disseminated the ACP documents to the family members, primary care provider, specialist and hospital