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What’s in a living will?
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share A living will provides a written record that can guide your doctors and loved ones in caring for you. Often, it’s used to determine how aggressive you would like your health care to be near the end of life. Be careful in describing your wishes, because it’s impossible to know all the variables that might affect a future decision. For example, if you say you don’t want to be tube-fed under any circumstances, you might be lowering your chance of recovery from a temporary health setback. Your physician can explain medical terms and discuss what’s possible and what’s unlikely to work given your situation and goals. It’s a good idea to talk to her or him before you finalize your wishes, whether you do that in a document or in conversations with your health care proxy, family, and friends. The information that’s required for a living will or other advance care directive differs from state to state. Caring Connections, a Web site of the National Hospice and Palliative Care Organization, offers downloadable forms by state. Living wills generally cover certain procedures that might be performed when a person is incapacitated or at the end of life, including these: Artificial nutrition (tube feeding). If you can’t swallow anything, this procedure supplies nutrients and fluids through a tube inserted through your nose into your stomach (short-term), through the abdominal wall into the stomach (long-term), or into a vein if your gut isn’t working properly. Tube feeding may be used as a bridge when the underlying problem is thought to be temporary and the person is likely to recover. More controversially, it has also been used long-term to help keep a person with an irreversible condition alive. Hydration (giving a solution of water, sugar, and minerals through the vein) can also be used short-term or long-term. Cardiopulmonary resuscitation (CPR). If your heart or breathing stops and you become unconscious, you may be resuscitated by CPR. This technique involves artificial circulation (chest compressions), artificial respiration (mouth-to-mouth breathing), and defibrillation (to shock the heart back into a steady rhythm). If CPR fails, the next step is advanced cardiac life support: intubation and mechanical ventilation plus medications to control heart rate, raise or lower blood pressure, or improve kidney function. CPR can cause injury, and the revival rate with CPR is low — no more than 22% in general, and as low as zero for older, frail people. Some people with terminal illnesses who have been resuscitated this way say they wish they hadn’t been. Think about whether there are situations in which you wouldn’t want CPR. Mechanical ventilation. A ventilator or respirator (sometimes called a breathing machine) forces air into the lungs when you can’t breathe on your own. Because the equipment is extremely uncomfortable, people on ventilators require high doses of sedatives and therefore are not fully conscious. Like tube feeding, mechanical ventilation can be used for a short period of time, as a bridge to recovery, or long-term. You should decide whether you want to be kept on mechanical ventilation if physicians determine you will never be able to breathe again on your own. [ Last edited by winzhouyun on 2011-5-4 at 22:26 ] |
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