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On Advance Directives

patient with iv line

Many have died during the COVID-19 pandemic. How many of them or their relatives were ready? I remember attending a symposium at a Philippine College of Physicians annual convention before the pandemic, on discussing with patients the possibility of dying. The speaker, an ICU physician, discussed advance directives. He asked a ballroom full of physicians, if anyone had an advance directive. Only a few raised their hands. It’s 2022 and I myself still do not have an advance directive though I’ve thought about it several times. Both my parents have told me, that for them when it’s time, to take no aggressive measures. My mother in particular, fears being intubated. She remembers visiting one of our relatives at the ICU. She never forgot the fear in the patient’s eyes, unable to communicate (as she was intubated) except with vague hand gestures. She even told me that she has instructed my younger brother to remind me (no aggressive measures!) should it come to that. I protest that intubation can be life-saving and that there are patients who successfully get extubated and survive.

All Souls’ Day is coming up soon. On the day we visit our relatives in cemeteries or columbariums, we will be reminded again of our impending mortality. On several occasions, I remember discussing with my husband that we should probably buy a columbarium just in case. But of course, we haven’t. In this study by McAdam et al (2005) on Filipino-American families, those with more education had a more positive attitude toward advance directives but knowledge and completion rate of an advance directive was low.

Advance directives are legal documents that allow you to spell out your decisions about end-of-life care ahead of time. They give you a way to tell your wishes to family, friends, and health care professionals and to avoid confusion later on.

According to this guide by the Mayo clinic, choose who will act on your behalf in case of illness. The guide also enumerates the possible end-of-life decisions you may wish to include in your advance directive.

  • cardiopulmonary resuscitation (CPR)
  • mechanical ventilation
  • tube feeding
  • dialysis
  • antibiotic or antiviral medications
  • palliative care
  • organ and tissue donations
  • donating your body

Let’s discuss advance directives at the #HealthXPH tweet chat 22 Oct 2022, 9 pm Manila time.

T1. Do you have an advance directive? Why or why not?

T2. Do you discuss having an advance directive with your patients? Why or why not? As a patient, has your doctor ever discussed an advance directive with you? How did you feel?

T3. What ways do you suggest to bring up and discuss an advance directive with patients? As a patient, when is the proper time to discuss an advance directive, and why?

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