Conscious Aging: End of Life Decisions

After being with Minga and talking with her about her change of heart in deciding to accept dialysis, I’ve been thinking a lot about end-of-life decisions and how they change in the light of actual experience. That’s why this story caught my eye:

A 70 year old Miami man was found unconscious on the street and brought to a hospital, where he was diagnosed with septic shock. Untreated, sepsis kills you pretty quickly — death occurs sometimes even with treatment. Sepsis is a hard thing to reverse. The man had Do Not Resuscitate tattooed on his chest, along with his signature. Doctors had to decide whether to attempt treatment, or whether to honor the instructions given via tattoo.

I have no plans to have my end-of-life wishes tattooed anywhere, but I know there’s a lot less certainty with such directives than one might think. If you arrive at an ER in critical condition, the ER team will likely start resuscitation even if you have documents floating around somewhere, either tacked to your refrigerator or online. If the ER team has only minutes to make a decision, they are not going to pause to check out your documents. They are going to stabilize if they can, and then your wishes might come into play re further treatment decisions. I also know that once something is started, like a respirator or a feeding tube, stopping it is a harder process than saying “no” in the first place.

The bias is toward keeping you alive. Clearly the guy with the tattoo had a different thought. After stabilizing him while they consulted ethics experts on what to do, the doctors were unable to reverse the sepsis anyway. The man died, and we’ll never know — if he’d regained consciousness — whether or not he might have changed his mind.

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