, 03.29.2020 10:37 AM

My living will, Jake Tapper and Brian Goldman

A living will is sometimes called an advance care planning document, or an advance directive. I call mine a living will, like the Americans do.

Basically, it’s a document that describes the care I would (and would not) want to receive if I’m not able to communicate my wishes about medical treatment.

My Dad had one, and he suggested we all get one, too. He was a doctor. He used to take me and my brothers to the hospital with him, sometimes, to gently remind us that sickness and death are part of the deal for all of us.

So, I got a living will. Originally, it was to give guidance to the love of my life and my youngest brother. But the love of my life dumped me, and my younger brother is far from where I am. (Everyone is far from where I am, these days.)

I got in touch with my estate lawyer, then, yesterday. He’s an amazing guy and a longtime friend. I told him I wanted my living will amended to specifically exclude the use of a ventilator or CPR when and if I get sick.

I decided to do that because of two people – Jake Tapper on CNN, and Brian Goldman on CBC. Truth.

I’m not friends with Jake Tapper, but I admire his journalism and his integrity very much. I periodically tweet funny stuff at him and he tweets funny stuff back.

A couple days ago, however, he had a New York doctor on his show and what the doctor said actually shocked me. The doctor said ventilators prolong “life,” but they don’t restore it.

Nobody ever really comes off the ventilators, he said. The clip is here, sent along by Jake Tapper. Around the four minute mark.

That shook me. I didn’t know that. I hadn’t heard that before.

Then, around the same time, Dr. Brian Goldman – the well-known CBC Radio doctor, and a friend who has given me advice that has helped get me through aforementioned difficult times – tweeted that, if he got sick, he would refuse a ventilator and/or CPR.

I thought about that for a minute, and then I tweeted: ditto. Use the machines on someone else. No heroic measures.

So, there you go. I told my daughter last night at supper, and now I’m telling you guys. None of my sons or brothers are around here to tell, so I’m telling you. I’m doing that to ensure it gets communicated to the right people at the right time, if needed.

Now, I’m pretty healthy. No health problems, no allergies, no headaches, no “underlying conditions” at all. I exercise, I eat right, I don’t do drugs, I dislike booze, I’ve never smoked, all that.

But this disease doesn’t discriminate. Young or old, rich or poor, healthy or not. So, if I get it – and, the available data suggests many of us will, eventually – I want the ventilators and doctors and nurses to focus their remedial efforts on more-deserving others. (If I get it bad, that is. Maybe I won’t. Who knows.)

Death is part of life, my Dad used to say to me and my brothers. So, if death beckons, all of you guys now know what I want, too.

You’re my living will. I’d shake your hand and thank you, but that’s not advisable in the current circumstances.

So it goes, I like to say.

18 Comments

  1. Ronald O'Dowd says:

    I hope people can learn from our experience: living wills are essential and copies not only need to be given to every retired and seniors’ residence you move to but also to hospitals, especially for people like our Mom who suffers from both Alzheimer’s and Vascular dementia.

    As a lawyer, you will appreciate that in many jurisdictions, living wills are sometimes simply ignored during sudden emergency or critical situations. (They want to reduce or eliminate the risk of lawsuits to near zero.) It’s even worse for people with cognitive problems, or other extremely serious and chronic health problems: à défaut, they will more often than not automatically resuscitate as that is the standard protocol in cases where no living will is in the resident or patient’s file. Being proactive is always the way to go for oneself and especially so for people who can no longer legally give or withhold consent.

  2. Grace Bradish says:

    Thank you. We have a similar pact in this house too.

  3. joe says:

    Mr. Kinsella, a living will is a great idea. And your decision to refuse a ventilator or CPR is your business not mine.

    But the comments that, “The doctor said ventilators prolong “life,” but they don’t restore it.” and “Nobody ever really comes off the ventilators” are puzzling.

    Later you said “I want the ventilators and doctors and nurses to focus their remedial efforts on more-deserving others.” But you wrote “nobody ever really comes off the ventilators” If that is true, why would we put anyone else on a ventilator?

    These points you make seem to be inconsistent.

    I reiterate that if you wish to refuse a ventilator, that is your right. If one of the reasons you are doing it is to save the life of a younger person, then that is admirable.

    But I think your sample size of doctors re the lack of ventilator effectiveness may be too small. Alternatively, it may be partially correct, but primarily for people above a certain age, or with existing conditions.

    • Warren says:

      Watch the CNN clip.

      • joe says:

        Mr Kinsella, I have seen the CNN clip and watched it several more times.

        You wrote, quoting the good doctor, “nobody ever really comes off the ventilators.” If NOBODY really ever comes off ventilators is true, then why would we put anyone on a ventilator is a valid question; for which you and the doctor didn’t state an answer.

        An answer might be, younger patients with no other health issues may be much better candidates for ventilators. The ventilator may give their bodies the time to combat the virus and naturally recover.

        But prioritizing younger, intrinsically healthier people for ventilators is different from saying “nobody ever really comes off the ventilators”

        Prioritizing will be a difficult decision for doctors to make. In your case you appear to have made that difficult decision for them and I applaud you for doing so.

        Doctors in Italy are reportedly already triaging patients for ventilators. Unfortunately, it sounds like this may happen in New York.

        If nobody really ever comes off ventilators is true, then perhaps the medical efforts should be to comfort the dying as much as possible and not try to prolong life (which may needlessly expose medical workers to the virus).

        My parents both had living wills and both of them while healthy made darn sure their family understood what that meant. When my mother went into hospital for palliative care she made me write “do not resuscitate” in six inch letters on the medical white board by her bed. She passed away a week later. It was a very sad time for us, but we were comforted since that was her wish.

      • Judy-Anne says:

        Some contradictory info around this: Our B.C. Provincial Officer of Health, Dr. Bonnie Henry, said just the other day that B.C. is now putting people on ventilators SOONER since finding that they experience better outcomes. Her words: “But it also helps people recover from the virus faster, so if you support their breathing earlier it means they often stay in hospital less time and have better chance of recovery. That is something the critical care physicians have been implementing across B.C., and as more people have been entering hospital we are seeing an increase of people going into ICU and being put on a ventilator sooner rather than later because that seems to improve the outcome.” I think she said other jurisdictions had noted this too and that we (B.C.) have had patients recover.

  4. Paige says:

    Good Luck with that.
    I’m sneaking up on 70 so have been going through winessing many relatives at end of life over the last decade or so. Some were sad, others less so. That’s life eh?
    It is amazing to watch the health care system systematically remove a persons autonomy. In every case it was the medical system not the patient or their loved ones making the final decisions.
    Sad reality. Anyways, I hope you never have to test out your directives.

    • Paige says:

      Oh another dismal thought.
      If you are in need of a ventilator during this current pandemic, you will be in isolation, 100% guaranteed. Therefore no one representing your interests will be permitted to be present when final decisions are made.

  5. Judy Kendle says:

    Would just like to report that several years ago I was on a ventilator for several days (about a week) and did come back to life afterwards without any untoward effects. This in the aftermath of sudden cardiac arrest. Perhaps I was extraordinarily lucky? Perhaps it’s dangerous to generalize?

  6. whyshouldIsellyourwheat says:

    People come off the ventilator. Here is a video from a New York ICU physician from a major hospital, now exclusively a Covid-19 hospital. He says some people often have to be on the ventilator for 7-10 days, but his team has successfully transitioned many off.

    https://vimeo.com/399733860

  7. Fred from BC says:

    The way I read this (and I could be wrong) most people who contract the coronovirus and get to the point where it is life-threatening for them will be elderly or infirm (or both). If they then need to be put on a ventilator, the chances are indeed very good that they won’t be coming off it.

  8. Jason says:

    Hi Warren-
    Scary stuff and it is an important thing to do (the living will and discussions around your end of life care wishes.)
    I’m an MD and, like all of us, am concerned and consuming tons of data- it feels like we still don’t know what we’re dealing with; there’s a big fog of war.
    I think we have to be careful spreading the rumour that you can’t come off a ventilator. The doctor here (on CNN) says they haven’t yet but the data from China and elsewhere indicates something more like 50/50 once you need critical care, and an average of 2-4 weeks on a ventilator before you can be weaned off.
    It’s true that it’s not a panacea; but the political forces to the south minimizing the importance or need of vents don’t need more help shrinking their responsibility.

  9. Robert White says:

    As a graduate of the George Burns School of Smoking & long time reefer madness consumer I, for one, will not be needing a ventilator. No self-respecting Coronavirus would inhabit my lungs I assure you.

    RW

  10. Many thanks for so many things in this article. Let’s start with the term, Advance Directives: Where healthcare industry would have us use their lingo/jargon, as you rightly point out Living Will is a much more familiar term – to us Canadians as well as U.S. (Rhetorical question: why confuse things in a topic that’s already fraught) Then there’s the topic of ‘machines to keep us alive’: how many of us (non healthcare professionals) know beyond vents and CPR.. and how many of us know more than what we’ve seen on TV. While COVID19 presents a specific situation, and a specific need/do not need; want/do not want Mechanical Breathing Machines, the dying journey presents so many more potential crises, decisions before any machines are yay or nay’d, I urge asking : if consent is given/not given (for any treatment/device) will likely happen? how will this affect present/future quality of life? I also urge recognizing what’s rarely acknowledged – whether in medical decisions or treatment: along with risks/harms and benefits, ‘Uncertainty’ is that rarely spoken reality-check.

  11. Steve Oliver says:

    Has anybody explained to anybody why a patient needs to be ventilated? I do not see it written anywhere. Its because our lungs are filling with heavy fluids/water. Its like a dry sponge getting heavier and heavier and becomes too much for our diaphragm to do the work of pushing to collapse the lungs to exhale and inhale any air capacity left. Feel free to expand on my limited knowledge.

    I think the patients with the best prognosis, all other things equal, is to get them on the ventilator before they collapse and before the lungs are too full of heavy mucous/fluids.

    Perhaps one of you respirologists or emergency/critical care physicians can expand on this.

    But lets get people on the ventillators early. Thats obvious. The next issue is when is it already too late for a good outcome. What are the measures to evaluate and decide? How long will it take to find a ventillator and begin treatment? This needs to be rapid and instant. Not several hours?

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