Thursday, April 30, 2020
Many older American's with chronic health issues, even if they have not contracted the novel coronavirus, are asking themselves a difficult question: if given the choice, would like want to die in a hospital's intensive care unit? Edo Banach, president of the National Hospice and Palliative Care Organization, recently had that conversation with his 69-year-old mother, Cheryl Goldman. She told her son that she would rather stay at home and receive hospice care instead of being admitted and being placed on a ventilator.
“It’s the kind of conversation everyone should be having with their loved ones,” Banach said. Depending on the source, one-third to two-thirds of Americans have not executed an advanced directive, which outlines what medical treatments they would accept or refuse and also designates a decision maker to act on their behalf if they become incapacitated. Many seniors and their families focus on do not resuscitate orders which deals with whether patients would want to be resuscitated after cardiac arrest. But advanced directives are the documents that involve the question of ventilation and intubation, which involves a tube inserted down the throat, connected to a ventilator that pushes air into the lungs. After an extended period of time on a ventilator - usually two weeks - doctors commonly perform a tracheostomy, creating a surgical opening in the windpipe that replaces the swallowed tube.
“After elderly people have been on a ventilator, they’ve often already developed physical debilitation, difficulty swallowing, bedsores,” said Dr. Kosha Thakore director of palliative care at Newton-Wellesley Hospital in Massachusetts. Further medical issues can be physical or cognitive or both, and are often permanent. Though the question may be hard to ask of loved ones, during these uncertain times it is becoming critical - "If you got really sick, would you want to take a chance and be placed on a ventilator? Or would you prefer to pass at home?"
See Paula Span, Do You Want to Die in an I.C.U.? Pandemic Makes Question All Too Real, New York Times, April 24, 2020.
Special thanks to Matthew Bogin, (Esq., Bogin Law) for bringing this article to my attention.