tag:blogger.com,1999:blog-7476621888383604834.post4119438210481114017..comments2024-02-15T03:26:38.897-05:00Comments on Health Care Organizational Ethics: A Tool for Discussing Wishes for End of Life CareJim Sabinhttp://www.blogger.com/profile/03087828142188534542noreply@blogger.comBlogger2125tag:blogger.com,1999:blog-7476621888383604834.post-53318723530061532962008-11-29T13:44:00.000-05:002008-11-29T13:44:00.000-05:00Hi Roy -It's always good to hear from you. Your "H...Hi Roy -<BR/><BR/>It's always good to hear from you. Your "Health Care Renewal" blog has been an inspiration for me!<BR/><BR/>I agree with you that "it depends" will typically be the initial answer to questions like "if there were a choice, would you prefer to die at home, or in a hospital?" (#2) or "could a loved one correctly describe how you'd like to be treated in the case of a terminal illness" (#3). <BR/><BR/>The literature does indeed show that our values are different at different stages of life. But I believe that if the ice is broken for a subject that is often taboo, at the very least the family member will have something to draw on in the future. And with luck the now-discussable topic could be returned to as needed over time.<BR/><BR/>The key question is - what happens after "it depends"? My hope is that there would be some back and forth discussion, as there was when I tried the five questions with my wife. For me, the die at home/die in a hospital question led to discussion of how much I believe in the concept of hospice, and how, in a circumstance of terminal illness, I hope that a hospice conversation would occur too early rather than too late.<BR/><BR/>Best<BR/><BR/>JimJim Sabinhttps://www.blogger.com/profile/03087828142188534542noreply@blogger.comtag:blogger.com,1999:blog-7476621888383604834.post-61580279556159869492008-11-26T16:56:00.000-05:002008-11-26T16:56:00.000-05:00But unless you are unfortunate enough to have a te...But unless you are unfortunate enough to have a terminal disease, how in the world should you answer this?<BR/><BR/>It seems to me, for a healthy person, or even a chronically ill person, the answer to every question except 4 would be "it depends." They would depend on the circumstances in which one would actually have to make such decisions. <BR/><BR/>For example, for a patient with a heart attack (myocardial infarction), the probability of a life-threatening arrhythmia is real, but the success rate of cardiopulmonary resuscitation for this circumstance is relatively high. So it would make sense for many people to answer 5 for question 1 were they to have a heart attack, knowing that background. <BR/><BR/>But it might be very different for someone who acquires a debilitating and painful chronic disease.<BR/><BR/>Furthermore, could you really predict what you would want or how you would feel if you were to be in such a situation? <BR/><BR/>In fact, the psychological literature suggests that people are not good at predicting their decisions or their values in advance were they to encounter some situation which they have never previously experienced.<BR/><BR/>So I am unfortunately skeptical that for most people addressing these sort of simple questions will lead to any kind of enlightenment.Roy M. Poses MDhttps://www.blogger.com/profile/00497209843184497847noreply@blogger.com