The importance of End of Life Issues

although this is an issue that many folks in this country like to ignore, in a hospital setting this topic is very important. I recently had a case where the gentleman presented from an outside hospital with a perforated colon. Luckily, he was able to get to our hospital in time and to the operating room where they were able to remove a good section of the affected colon. The patient became somewhat hemodynamically unstable during the surgery and they had to stop early and planned for a return to the OR the following day.

The difficult aspect of this case arose when both the son and the second wife appeared and claimed that they had health care power of attorney over the patient. This became quite a conundrum since one family member noted almost diametrically opposite from the other. We referred this case over to our risk management department and they sided with the family member who had appropriate paperwork. Apparently the patient was deemed incompetent and had guardianship transferred to one family member, and the other family member had papers that were signed after the patient was already declared incompetent (likely due to Alzheimer's).

Regardless, the patient became very unstable and the family member who had guardianship made the patient DNR, or do not resuscitate. Everything was being done for this patient, mechanical ventilation, fluids, medications to maintain blood pressure and heart rate (pressors), etc. However, the family member who did have power of attorney did not desire to have chest compressions done. The patient eventually expired.

The entire episode became a family circus when the other family member who did not have guardianship objected to the decisions the other family member made. The moral of the story is that you should have any plan or discussion with your family members in the event that you become critically ill. It is unfair to put the burden on Hospital staff to make decisions that you should have had with your family members. The general public also needs to understand that dying is a natural process, and prolonging life on artificial means leaves little to no quality of life. Are you planning on taking your loved one home on a mechanical ventilator? Or perhaps you could just be like most of America and leave the burden of care up to the hospital...