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6. Treatment Preferences in Critical Medical Circumstances

6.1. Medical Actions

Determining the kinds of treatment you want to receive in critical medical situations are choices that are unique to your own medical circumstances and personal choices. As stated in Section 4.1, it is essential to gather reliable information about any pre-existing medical conditions you may have. It is also critically important to discuss the effect of various treatments with a doctor that you trust. However, it is impossible to predict all the potential unforeseen circumstances that could occur in a medical emergency; for this reason it is important to communicate clearly about situations in which you want life sustaining and life enhancing measures.

You might think of yourself as being on a continuum with several stops along the way. You may or may not prefer different medical actions at different places along that continuum. A diagram to show this continuum might look like this:

Excellent Health

1

2

3

4

5

End of Life

Health Level #1 is defined by me as _____________________________________________________________________________

Health Level #2 is defined as ____________________________________________________________________________________

Health Level #3 is defined as ____________________________________________________________________________________

Health Level #4 is defined as ____________________________________________________________________________________

Health Level #5 is defined as ____________________________________________________________________________________

One way to begin a discussion concerning medical actions is to gather information about medical procedures and treatments and then decide what you would like to have happen. Using the Internet for research can be helpful. There are community access computers at several locations throughout the province where you can “go online” free of charge. Phone the Independent Living Resource Centre (947-0194 or toll free number 1-800-663-3043) to see if a community access computer is in your area and if it is accessible.

The following list provides some suggestions of medical procedures that you might want to consider. A critically important person to include in your discussion is your doctor. Asking what each procedure would involve for you and your distinct medical situation is critical in your decision-making, and this may change depending on your overall health. You may want to refer back to the arrow diagram - if, for example, you were in excellent health prior to an accident, you may want more life-sustaining medical procedures than if you were in the end stages of a terminal illness.

What are your medical preferences concerning:

Transfusion of blood and blood products? __________________________________________________________________________ ____________________________________________________________________________________________________________

Cardio-pulmonary resuscitation? _________________________________________________________________________________ ____________________________________________________________________________________________________________

Diagnostic tests? _____________________________________________________________________________________________ ____________________________________________________________________________________________________________

Dialysis? ____________________________________________________________________________________________________ ____________________________________________________________________________________________________________

Pharmaceuticals? ____________________________________________________________________________________________ ____________________________________________________________________________________________________________

Nutrients &/or hydration by tube? ________________________________________________________________________________ ____________________________________________________________________________________________________________

Mechanical Respirator? ________________________________________________________________________________________ ____________________________________________________________________________________________________________

Surgery? ____________________________________________________________________________________________________ ____________________________________________________________________________________________________________

Pain management? ____________________________________________________________________________________________ ____________________________________________________________________________________________________________

Organ transplant? ____________________________________________________________________________________________ ____________________________________________________________________________________________________________

Have you had previous experiences with medical technology (using a mechanical respirator, dialysis, tube feeding, transfusions, etc.) and if so, is there anything learned from that experience you feel a health care provider should know?
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Other concerns: ______________________________________________________________________________________________
____________________________________________________________________________________________________________
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6.2. Personal Care Preferences

Review the questions you completed in Section 5. Pay particular attention to any answers concerning your personal care. You may want to look at questions 4, 6, 7, 9, 10, 14, 15 and 16 as a way of getting started.

Summarize below what kind of personal care you would prefer if you were in a critical medical situation. This could include comments about bathing, dressing, feeding, bathroom routines, brushing your teeth and hair, or any other part of your personal care routine.

____________________________________________________________________________________________________________
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____________________________________________________________________________________________________________
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You can include this summary in the documents you are giving to your physician, substitute decision-maker and other designated person(s). See Section 11.


6.3. Personal Support

Who do you want to have with you when you are in a critical medical situation? What kind of emotional support will you need? Do you want someone with you at all times? Are there people you will not want to have around you? Who should look after your pets &/or your children? How do you want your illness explained to others? Should someone inform the place where you work/serve as a volunteer? Do you want someone designated as a main contact person with whom others in your community can communicate in order to know how you’re doing? Do you want to see a rabbi, priest, chaplain or other religious leader? If you have children, how do you want them to be told of your condition? Are there poems, scripture, readings, or songs that you would want someone to read, even if you are not conscious? Would you want a photograph of a special place or a loved one nearby? What kinds of actions or items would be offensive to you that others may not necessarily know about?

These are all questions to contemplate when thinking about what you would like to have happen in terms of personal support. It might also be helpful to review Section 5 again, paying close attention to questions 17, 23, 24 and 25. Summarize on the following lines your preferences for personal support.

____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
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You can include this summary in the documents you are giving to your physician, substitute decision-maker and other designated person(s). See Section 10.


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