As of Saturday, December 14, 2013
DEAR DOCTOR K: I’m drawing up a living will, but I don’t understand many of the medical terms I’m encountering. Can you help?
DEAR READER: Many people, certainly including me, have asked themselves how they would want to be cared for if they became very sick and unable to speak for themselves. The two most common ways of doing that are to designate one trusted person, such as your spouse, who knows your wishes to make decisions for you — a health care proxy. Another is for you to write a living will.
In a living will, you specify how you want to be cared for. Living wills can be the sole way you make your wishes clear to the doctors who someday may be in charge of your care. It also can be a guideline for someone who is your health care proxy.
A living will is used to determine how aggressive you would like your medical treatments to be as the end of life nears. I’ll explain several terms that you probably are seeing in a draft living will. As you read, think about whether you would, or would not, want certain procedures or care.
— Artificial nutrition. When you are unable to swallow anything by mouth, nutrients and fluids can be supplied through a tube inserted through your nose into your stomach. Such a tube can’t be left in long-term (beyond a few weeks). For longer-term use, a tube can be inserted directly into your stomach. That requires a minor surgical procedure. Also for longer-term use, a tube called a catheter can be placed into one of your veins if your gut isn’t working properly.
— Cardiopulmonary resuscitation (CPR) and advanced cardiac life support. If your heart or breathing stops, CPR can be used to try to resuscitate you. CPR is a combination of chest compressions, artificial respiration and defibrillation. In artificial respiration, air is squeezed through a mask placed over your mouth and nose to move air in and out of your lungs. Defibrillation delivers an electric shock to your body. This can restart your heart if it has stopped beating. The next step is advanced cardiac life support, including mechanical ventilation.
— Mechanical ventilation. A ventilator or respirator pushes air into your lungs if you cannot breathe on your own. A tube attached to the machine is inserted into your nose, mouth or neck (through a small surgical procedure). However the tube enters your body, it is passed down into the trachea (windpipe). Mechanical ventilation can be used short-term as a bridge to recovery, or long-term.
— Organ-sustaining treatment. This is a set of drugs, medical procedures and machines that can keep you alive for an indefinite period of time. Mechanical ventilation is one common example. Another is kidney dialysis, a machine that cleans toxins out of your blood when your kidneys cannot do the job. Such treatments cannot cure a terminal condition.
I’m like most people: I didn’t exactly look forward to drawing up a will or a living will. But I saw the burden that not having done so caused the families of my friends and patients. That convinced me to do it.
Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.