4. Your 'Living Will' Should Not Apply in Emergencies.
Your Advance Directive for Medical Care is
intended to guide decision-making under normal conditions, where
all the facts are well known and understood by everyone involved.
If you are suddenly injured in an automobile accident, you
should not expect your 'living will' to apply, at
least while your condition and prognosis are still unclear.
Thus, if you say you want no
will be ignored if you would die without a transfusion. The
ambulance attendants and the people who will take care of you in
the emergency room do not have to read your Advance Directive for
instructions about whether or not to start an intravenous line, whether
to re-start your heart, or restore your breathing. These
things must be done immediately
or you will certainly die.
Because it is understood that emergency medical personnel have
a primary responsibility to save your life, you
might put this exception into your Advance Directive. Then
your relatives will not try to pull out the tubes in
a misguided attempt to follow your Advance Directive.
However, dying at home might not be a medical emergency. If
you are planning to die at home, this is your right. And
you should make it known to all the people around you that
you do not want
anyone to call for medical help when you die. You
should inform your emergency medical service and
the county medical examiner or coroner that
your death is expected at home so
that no medical emergency personnel need be called. This
amounts to a Do-Not-Resuscitate order at home. (Question
13 discusses DNR orders more completely.)
Normally if you begin to die suddenly and unexpectedly, it
is best to call the paramedics immediately, so
that they can stabilize your condition, giving
more time for a proper evaluation of your prognosis. The
fact that emergency measures have already been started should
never be a factor in a later decision to terminate treatment.
Thus, even if the ambulance team manages to save you, you
might still choose to die once your complete situation is known. Perhaps
your remaining life would be short no matter what is done. Maybe
your were dying of cancer when you were in a plane crash.
YOUR LAST YEAR: CREATING YOUR ADVANCE DIRECTIVE FOR MEDICAL CARE
possibly you would be in a coma for the rest of your life. And
you should decide what quality of life is too low for you. You
always have the right to end your life for good reasons. And
the fact that you have received emergency treatment because
of an accident does not take away your right to die. So
you should not rule out emergency treatment because
you fear that once you are in the hospital, you
will be forced to undergo everything medicine can do for you. Once
the emergency has passed, then
deliberative discussion about your care can begin, with
detailed examination of your Advance Directive if you have one and
further discussion with you if you can still participate.