I'm a solo ager and feel good about the decades of life I've already enjoyed. Taking care of mom is my final moral obligation. One must always knock on wood, but I feel pretty confident that I will live long enough to continue to see to my mom.
After that, however, my hope is to not pass any offramps: for example, no resuscitation, no tubes, no cancer treatment beyond maybe surgically removing a mass if that helped with alleviation or prevention of pain/discomfort... (In all candor, I'm sort of hoping for cancer since the Big C seems like an old Disneyland E-Ticket in terms of aid-in-dying options.)
I think I would experience more peace on a day-to-basis if I worried less about falling into the clutches of modern medicine (alleviation of pain/discomfort excepted)
So... What should I be listing in my advance health care directive in order to not leave any loopholes?
(I'm aware that the advance health care directive is itself sort of hit or miss, but this question assumes a perfect world where my stated wishes would be honored.)
Here's my working draft. It assumes an already-bad situation.
No life-prolonging treatment
Do Not Resuscitate
Do Not Defibrillate
Do Not Intubate
No Dialysis
No Antibiotics
Do Not Leave Home (unless experiencing pain/discomfort that cannot be managed in the home)
No Intravenous Lines (except for purpose of comfort care)
No Blood or Blood Products
No cancer treatments unless essential to palliation
No Blood Draws
No Feeding Tube
No artificial hydration or nutrition
No food or water that I do not explicitly request (do not bring spoon to my face)
Do Not Operate
No monitoring that does not directly support comfort care
No medications unrelated to alleviation of pain/discomfort
No inoculations
Is there something obvious or important that my list is missing?
It could be argued that every item after the first is redundant, but it seems that "no life-prolonging treatment" alone is sometimes dismissed as insufficiently specific?
Sorry if this topic seems ghoulish. Again, my short term goal is to try to manage what has become obsessive thinking about fates worth than death. The goal is peace and contentment in the day to day.
If you're in no fit state to consent to a given procedure and your team is in any doubt about the value of it *to you*, this is all the guidance they need.
And I don't want to be ghoulish either but without even trying I can think of a lot of situations where you really might want treatments which you've excluded up there.
I like the phrasing "prioritize quality of life." I worry about ambiguity, but I take your point about the breadth of the list.
BarbB: The California POLST instructions say "A POLST works together with your advance directive, providing more specific detail regarding medical wishes and goals of care during a serious illness or at the end of life."
It also requires a doctor's signature (which is sort of irritating). I wonder if a doctor would even be willing to sign off if I wanted a POLST that ordered "comfort-focused treatment"?
But yes, this is obviously the much more reasonable starting point than the thing I attempted to cobble together on my own. Thanks for that reminder.
Next step is do your POLST with your doc. Essential it is to be posted in your home so the EMS cannot do CPR on you. They look for it on refrigerator door, but anywhere you choose to post it should work Some states I have heard doesn't allow polsts. My own does..
And yes, these documents need to be findable--fridge and maybe also medical alert bracelet alerting EMS to location of docs. Will keep thinking about this...