Being MortalAtul Gawande
Presenters:
Wendy McCarty, Director-CHI Health at Home-Dickinson
Tami Christianson-Social Worker, Bereavement and Volunteer Coordinator,
CHI Health at Home-Dickinson
Courage
-What is courage to you?
-Can it be physical, mental, emotional-just
foolish?
-Plato’s definitions of courage:
*Endurance of the soul
*Wise endurance
*Knowledge of what is to be feared and
what is to be hoped
*Courage is strength in the face of
knowledge of what is to be feared or
hoped
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Three modes of patient interaction
by doctors:
According to Gawande-
1. The doctor knows best approach
2. The informative approach
3. The interpretive approach
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Tough Questions
-When should we try to fix, and when should we not?
-Why do you think it is so difficult for Doctors and/or
families to refuse or curtail treatment?
-Do you think that advancements in the medical field
damage our ability to have a quality end of life?
-How do you walk the fine line between being hopeful and
being unrealistic?
-What do we really expect of medicine?
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VideoBeing MortalAtul Gawande
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Discussion Points
-Should medical schools expand the
curriculum to include end-of-life issues?
-What is your attitude, toward old age?
-Should doctors intervene if they think the
patient made a bad choice?
-How do you think your family would react if
you told them, “I’m ready”?
-What do you fear most about the end of
life?
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Planning Ahead: Advance
Directives and End-of-Life
Decisions
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Our Goals
 Discuss
advance directives and
end-of-life care decisions
 Learn
the different types of
advance directives
 Recognize
advantages and
disadvantages of advance
directives
 Identify
resources that can help
you complete your advance
directives.
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Do you have a Map?
….a written plan
stating what health
care treatments you
would or would not
want if you could not
speak for yourself?
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Why YOU Need an
Advance Directive
 Your
wishes will be known
 Only
used if you are unable to
express your decisions
 This
can happen to anyone-at
any age
 Give
your loved ones the gift of
peace of mind-write down your
wishes!
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Interesting to note…
Most
Americans-88 percentfeel comfortable discussing
issues relating to death and
dying
Yet research has found that
only 42% have a living will.
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What are Advance
Directives?

A written statement of your
wishes, preferences and
choices regarding end-of-life
health care decisions.

A tool to help you think
through and communicate your
choices

It is a road map for your future
health care.
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Advance Directives
Written instructions about future
medical care are only used:
 If
you are seriously ill or injured AND
 Unable
to speak for yourself
Two parts to an advance directive:
 Living
will
 Medical
(health care) power of
attorney
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Living Will
A
living will is one part of an
advance directive
A
legal document with your wishes
about medical treatment
 You
choose what you do want &
don’t want
 Think
 It’s
of it as a route on your map
YOUR journey
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Medical Power of
Attorney

A document that specifies who you want
to make decisions about your medical care

The person is authorized to speak for you
ONLY if you are unable to make your own
medical decisions

May also be called:
-Health care proxy or agent
-Health care surrogate
-durable power of attorney for health care
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Advance Directive
Advantages
 You
are in charge of making your
own decisions
 Documents
 You
can be changed anytime
DO NOT need an attorney
 Documents
can help you express
your wishes
 Forms
are available for FREE at
www.caringinfo.org
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Advance Directive:
Disadvantages

Advance Directives (AD) may not be
available when needed

Not readily available in patient charts

Living wills:
-may not be specific enough
-may be overridden by a treating physician
-does not immediately translate into
physician’s orders
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Medical Terms: End-of-Life
Care Decision Making
 Life-Sustaining
Treatment
 Artificial
Nutrition and Hydration
(tube feeding)
 Cardiopulmonary
Resuscitation
(CPR)
 Do-Not-Resuscitate
 Palliative
 Hospice
Order (DNR)
Care
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Other Directives
POLST
MOLST
Five
Wishes
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Free Resources from
CaringInfo.org

State-specific advance directive forms

Information on “Planning ahead” and talking with
loved ones and care providers

Brochures to download:
-Understanding Advanced Directives
-You have filled out your Advance Directive-Now
what?
-End-of-Life Decisions
-Conversations before the crisis
-Ask Tough Questions
-Communicating end-of-life wishes
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Additional Information Available to
you at:
http://chiathome.com/
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