Advanced Directives for Medical and Financial

Some of the treatments for cancer seem barbaric. These seemingly inhuman treatments, sometimes life-saving, hold some cancers at bay or are responsible for putting some patients in remission of their cancer.

Other forms of cancer continue to grow and spread throughout the body, in spite of all the marvelous treatments in our world today.

A few years ago I read a story and heard the same story on the television news. I wanted to pass on to readers what I heard in hopes that it may help someone else.

Can my right to make my own medical decisions be taken from me?

Nurses get a bird's eye-view of how the patient, their family, and their doctor feel on many different issues. The nurse is the patient's advocate. That is to say; it is the nurse who has a responsibility to stand up for the patient and their family and fight for specific patient rights, next to the family.

I will say at this point that many a nurse may not want to get involved.

The nurse is the eyes, ears, and voice for the patient's family, the patient, and their doctor.

Nurses as Advocates

A Nurse's Opinion

As a nurse, when I read the following news story a few years ago about a patient having no choice in her cancer treatment, it made my blood boil.

I have always felt that each person has the right to make his or her own (well-informed) health decisions when they reach the age of responsibility. It remains a wise decision to still rely on loved ones to help guide those decisions. I have seen parents talk about critical medical decisions with their very young children from about five years of age.

I have taken care of young children with terminal cancer and these children become pillars for their mom and dad. I cannot describe the amount of strength these children possess and pass on to the parents.

The Age of Responsibility?

What does society consider the "Age of Responsibility?"

In a legal sense, 17-years of age is a fine gray line between being able to make most self-directed decisions and not being old enough to make decisions. Some states declare that at 17-years of age the person is of semi-independent to independent status. Most states rule that 18-years are the age of independence in legal decision making.

We also have a group of patients who may or may not be seniors and have impaired cognitive functioning due to a wide range of causes, such as but not limited to dementia, Alzheimer's, congenital deformities, and much more.

Some adults act like they are still in grade school and could not make a reliable decision if their life counted on it. Some 17-year-old teenagers show a lot of common sense and excellent decision-making capabilities a lot better than some adults I know.

I believe that if a person has any cognitive abilities to make the slightest decisions in life, their voice needs to be heard, if at all possible. The decision-making process concerning a patient's life is a patient's right.

Until a child reaches the age of legal responsibility of that state, it is their parents or guardian who make the decisions, including medical treatments, medications, and financial concerns. In all fairness, this advocate must consider the maturity of the young adult. Decisions should weigh heavily on that person's desires.

Our Justice System

It should be the patient and their family who decide the course of medical treatment, which is not always the case. It is okay for their doctor to agree to disagree. In the end, it is up to the patient with the total or partial help of the family.

A Sad Story

The following story appeared in the news a few years back and involved a 17-year old female cancer patient in Connecticut who was forced to undergo chemotherapy as her treatment.

Apparently, this teenager had undergone chemotherapy once and did not want the treatment anymore. This young adult, not yet at the age of responsibility, desired to look into alternative medicine for her cancer treatment.

I realize that there are two sides to every story, and this side of the story is what made my blood boil.

Her court documents said that she was suffering from Hodgkin's lymphoma and strongly felt that the chemotherapy did her more harm than good. Because she refused treatment, the doctors sedated her repeatedly and tied her arms and legs down to the bed. The doctors implanted an IV port in preparation for the chemotherapy that she did not want.

Quite frequently when a patient must receive a harsh IV solution, such as chemotherapy a port is implanted under the skin, usually at the collarbone. Smaller IV tubing threads through the main artery in preparation for the cancer treatment. The arteries are more durable and able to withstand the harsh chemotherapy. These ports and IV tubing last for weeks.

These types of IV solutions are too harsh to run through regular veins. The solution would quickly break down the painful vein and surrounding tissue lasting for only a few doses.

By the accounts from the news, it sounded like the parents were on board with their daughter's decision to refuse further chemotherapy and supported her decision to look into alternative treatment methods.

If I understand the article correctly, the doctor implanted this IV port without the consent of the parents or this patient. This action by the doctor prompted the parents to hire an attorney.

The article went on to say that the Connecticut Supreme Court ruled in favor of the teen and her parents and ruled a violation of patient rights by the hospital and the doctor.

The article does not say anything beyond what the court did about the situation. She was discharged home with a chemotherapy schedule that spread out over several weeks.

Her story continued to get worse. I assume that she refused to follow through with the chemotherapy after returning home so Child Protective Services removed her from her home and placed her in Foster Care, appointing the Forster Parents to transport her to and from chemotherapy visits.

According to Connecticut law, the day she turns 18-years of age, she can make medical decisions on her own, but as for now, the decisions are being made for her. The news said that she was less than six weeks away from her 18th birthday.

What about the parents?

Apparently, the parents had no voice, and if they did not agree with the doctor and tried to uphold their daughter's desires, the authorities threatened to put their daughter in foster care, and this is what the news said happened!

How traumatic it must have been for the parents and this teenager who is already suffering from cancer. This teenager needed the support of her parents and family through this uncertain illness, not strangers. This whole situation was too sad and unbelievable to read.

I wholeheartedly agree with reviews from this article that something is too wrong with our society today. Too many times the justice system seems to turn upside down. Anyone who has had chemotherapy knows that this is a hard treatment and not at all pleasant. I feel that the way the hospital tied her down and sedated her was barbaric and wrong.

Some feel that health decisions should be allowed in minors under the age of 18-years. I say that it all depends upon the maturity and understanding of the individual.

Unfortunately, there is nothing set in place to sort through all of the particulars. Some teenagers have more common sense than many adults do three times their age.

In my opinion, this whole scenario is scary. Put yourself in this patient's position, and try to deal with a treatment you do not want and have the therapy forced upon you.

What happens if you do not have an advanced directive?

In most states, if you do not have an advocate in place, this gives your medical staff and strangers the right to make serious decisions for you when you cannot make the decisions on your own accord. Their choice for your care may not be the satisfaction of you or your family.

**This article is of personal opinion and experience of the writer. This article is not meant to give personal legal advice to the reader. The reader should contact their attorney for guidance and direction regarding medical and financial protection through:

• Advanced Directives
• Living Wills
• Wills
• Guardianships