By Fr. Mark Miller, CSsR, for the Catholic Health Association of Saskatchewan (CHAS)
(Reprinted from the June 2020 edition of the CHAS Communique)
As the pandemic reality has hit home in Canada, I have heard many calls for citizens to plan ahead by thinking about the treatment they might want or not want should they be afflicted by the COVID-19 illness.
In the midst of the present crisis it is assumed that Advance Health Care Directives (ACDs) would be enormously helpful when critical decisions have to be made for seriously ill patients.
I always have a double reaction to such calls for ACDs. On the one hand, I strongly believe in them and their potential usefulness. On the other hand, I find that healthcare providers can sometimes see ACDs as a short-hand form for making decisions which may be correct legally, but not very compassionate in the care of a patient.
Today, with the potential for the health of any of us to change dramatically should we contract COVID-19, I want to err on the side of preparation, and here are three suggestions.
First, the most important part of an ACD is the appointment of a proxy or substitute decision maker. Should you lose the capacity to make decisions for yourself, it is enormously helpful for staff to have a clear, written statement of the person(s) you appoint to make treatment decisions for you.
To make the document official in all provinces, one or two witnesses, other than the proxy, need to sign the document. And if you appoint more than one proxy, please provide a method for them to come to a decision if they differ among themselves (for example, x makes the decision, after talking things over with y and z).
Whomever you appoint as your proxy now needs to hear from you what your wishes would be.
If you are elderly and/or afflicted by other illnesses (such as diabetes or congenital heart disease or kidney failure), COVID-19 could be devastating and I have heard statistics that 66% to 80% of intubated patients (of all ages and conditions) do not survive the illness.
I have also heard from a number of nurses who have told me that they would not want to be intubated at all because of how harsh the treatment experience is, how it steals any final opportunities to say goodbye to family, and how the outcome can be very poor. In other words, before you tell your proxy what you might want or not want, get as much information as you can and think of your current health situation.
Second, talk with your proxy. While you cannot anticipate exactly what you might go through, give your proxy some idea of how you would make decisions. Being a proxy is a difficult task when the crunch comes, but it is a whole lot easier if you have had some discussions beforehand.
Third, written instructions can be helpful, but, in my opinion, they should be interpreted by the proxy rather than the health care team. The proxy can talk with family or friends to support his/her own sense of the wishes of the patient. Written instructions, however, can sometimes be helpful if they are needed to convince family members that the patient’s wishes are clear and not to be overruled.
The coronavirus is dangerous and fatal in a small percentage of cases. Hence, having somebody able to converse with the doctor about your wishes might be the best gift you can give your family and, I expect, the medical team. That is why planning ahead, preparing a proxy document, and talking over possible situations with your proxy could prevent a crisis response as decisions need to be made.
If you are interested in learning about the work of CHAS or would like to become a member, please contact Blake Sittler at email@example.com or (306) 270-5452.