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Those Crucial Life Decisions

December 18 2017 - by Dr. Derrick Aarons, Ethicist, Caribbean Public Health Agency

Motor vehicle accidents, strokes and severe illnesses that leave us mentally incapacitated and unable to make decisions for ourselves happen almost daily to people.  This often requires that some next of kin make health care decisions on behalf of those who have been so incapacitated. As a leader in your organization, you also have a role to play in assisting to maintain a healthy work force that involves not only the physical but the mental well-being of your employees.  However, mental health (of yourself or your employees) will be severely challenged if a loved one undergoes such a traumatic, life-threatening event.

Consequently, you should ask yourself and your employees - do you know what your parent, partner, best friend, or family members' wishes are regarding what they would want if they became incapacitated and thereby unable to communicate what they wish for their lives and how they hope to be cared for?  If not, we should anticipate and plan for such possibilities, engaging our loved ones in these discussions earlier rather than later, since tomorrow is promised to no-one and we are only guaranteed today in our day-to-day existence.

 Future care

 In raising such matters with our loved ones, it allows us also to reflect on how we ourselves would want to be cared for.  If we had a life-limiting condition such as terminal cancer, would we wish to be cared for in hospital or at home, and by whom?   In which surroundings would we want to spend the last few days of our lives?  If in hospital, would it be public or private?   If private health care, who would bear the attendant costs?  

If you are not yet near the end of life but you are no longer able to physically care for yourself at home, would you prefer to live in a long-term assisted care facility such as a nursing home, or would your preference be for living with a relative, and if so, which relative?  Pre-commitments from specific persons would be required in most of these arrangements, and so should be seriously thought through and all conditionalities planned for and met in advance.

 Get regular check-ups!

 Although most of us do not want to consider it, we all must die at some time, and some persons close to us will die sooner than others.   We ourselves live by faith or the belief that our lives are open-ended rather than time-limited.  Many of us go by our feelings about our bodies rather than getting a doctor’s check-up every year, and as long as we feel healthy then we presume that we are healthy. 

We do not consider that our bodies and mind cannot detect certain diseases when they start, particularly if they commence in areas when no sensory cells are found.   Our bodies are designed to feel (sense) what happens on the outside to protect ourselves, but not from areas inside our bodies where there are not normally any threats (for example, the pancreas, the prostate, and the liver).  Yet, diseases like cancer can start in any of these areas and you would never detect it early if all you are going by is your feelings!

 Accidents and illness

Statistics show that motor vehicle accidents, inter-personal violence, unanticipated severe injuries, severe infectious and debilitating diseases, cancers affecting both the young and old, and several neurological diseases with debilitating consequences can strike at any time and render us needing help and decision-making.   Further, our television news each evening illustrates how lucky we are not to be the casualty that has come to some ill-will that day.  

Our conversations about these matters should therefore be open-ended, and persons should contemplate various life scenarios, and what would be their preferences in each.  The conversations need not be about what they don't want, but about what these persons would want.   If they were to become seriously ill, would they want aggressive medical or surgical interventions, or would they want people to ‘back off’ in a situation where recovery is unlikely.   Even if they would not wish to contemplate any details, persons should be able to give you at least a general idea about what they would wish.

 The time is now

 You may also ask your loved ones (and likewise decide for yourself) whom they would wish to be their main decision-maker, and to begin having conversations with such persons so they both can become comfortable with the idea of such deep-rooted decision-making.  They should be able to trust that such persons know their values and would make decisions in their best interests should they not be able to do so themselves. 

You and they may not come up with all the answers or agree on all eventualities, but you would have begun a journey of planning for many possibilities in the future, which makes you much more prepared than others who may suffer catastrophic loss for which they are very ill-prepared.

Regardless of our religious beliefs or life philosophy, we can be certain that our existence here on earth is not only finite but can end without warning, and so the time to begin such conversations is now.  Please engage your employees and have them commence thinking on these matters for their own mental health and preparedness.

  

Derrick Aarons MD, PhD is a consultant bioethicist/family physician, a specialist in ethical issues in medicine, the life sciences and research, and is the Ethicist at the Caribbean Public Health Agency – CARPHA.  (The views expressed here are not written on behalf of CARPHA)

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Lois Parkes - Reply

This is a topic we tend to avoid but is so very important. Reality check

Solange Baptiste - Reply

This is a truly sobering article.  Moments ago, having seen the introduction to this blog I was thinking that perhaps annual check-ups should be mandatory for public sector employees as part of a proactive health service regime.  Some typical  and emmerging questions would be "how would this be paid for?"; Should  ther  be options as to the  extent of the  check-up?; Would  such a move  have  impact on our Labour laws?"

It  would make for  very interesting  debate and consultation to see if such a venture  could  be  reasonably approached and implemented  as a proactive health and  wellness venture.  

Tammie Walters - Reply

The information in the article is not only timely but we must take it seriously and act accordingly.

Suaine Graham - Reply

Although we are quite cognizant that these situation are likely possibilities this blog really brings it to the forefront of the readers mind that there is a greater need for  discussions on the aforementioned.

Subsequnetly, in addition to having that heart to heart discussion on the preparation of this likelihood, there also needs to be greater effort in both public and private sectors to further highlight the need for health/insurance policies as a saftey net for families and love ones in such an unfortunate event.

I do concur with the comment of Solange, should the act of an annual check-up be weaved into the company's policies? and to what extent?