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Planning for the worst with medical directives

Marc Gutierrez

Although we may like to think that we will always have control of our lives, there may come a time when we are incapable of making sound decisions for our health.  Determining the best way to deal with those situations is difficult, but thanks to advances in medical ethics it may be a little easier.

This week on “Take Care,” Dr. Barron Lerner talks about the different kinds of medical directives and how they can help make an illness-related death easier on the patient’s caregivers. Lerner is an author and professor of medicine at New York University.  His most recent book is "The Good Doctor: A Father, a Son and the Evolution of Medical Ethics."

Click "Read More" to hear our interview with Dr. Lerner.

In the past, doctors have been required to do whatever they can to keep a patient alive.  While such an approach seems logical, it is not always ethical, as patients could go through extended periods of unneeded suffering.

Lerner says that “sometimes it’s obvious what to or what not to do, but oftentimes it is much more ambiguous.”  

Medical directives help make the treatment options in such conditions as fair as possible according to the patient’s wishes.    

Although there is no best time to bring the subject of medical directives up, Lerner says that “the ideal time is when the person is perfectly healthy and you have a little extra time to discuss future issues.” 

There are three types of medical directives: DNR (Do Not Resuscitate) forms, living wills, and health care proxy forms.

  • DNR forms are used when a patient’s heart has stopped and the doctor needs to know if they should take action. 
  • Living wills are directions given by the patient at an earlier time that dictate how the patient should be treated should they be incapable of making decisions for themselves. 
  • Health care proxy forms involve the selection of a proxy to make decisions for the patient based on knowledge of the patient’s philosophy. 

Once you have decided which type of directive to use, the process of getting one is fairly simple.  In New York state, the form requires two witnesses to become a legally binding document.

Medical directives are far from perfect, but they do help alleviate some of the pain associated with end-of-life situations.

“When the forms are filled out properly and there’s been a careful selection of the person and some kind of discussion with that person, they usually work pretty well.”