Healthcare Decisions Day

Healthcare Decisions Day is a project used to inspire, educate and empower the public and providers about the importance of advance health care planning.

I am glad to hear that America is continually promoting awareness of the importance of the advance directives.

In America, April 16 has been declared on National Healthcare Decisions Day, “part of a national campaign to encourage Americans to complete their advance directives or living wills and document their desires regarding medical treatment at the end of life. ” http://www.nhdd.org

I support this project.

In the Philippines, I think we should also have a national campaign similar to that in the USA to encourage more Filipinos to make their advance directives or living wills.   Awareness and advocacy campaigns should be conducted by both physicians and health care institutions regardless of specialty.  The campaigns should not be delegated to the hospice specialists only.

Advance care planning starts with talking with your loved ones, your healthcare providers, and even your friends- all are important steps to making your wishes known. These conversations will relieve loved ones and healthcare providers of the need to guess what you would want if you are ever facing a healthcare or medical crisis.

“Advance Directives” are legal documents (Living Will and Healthcare Power of Attorney) that allow you to plan and make your own end-of-life wishes known in the event that you are unable to communicate.

http://www.caringinfo.org/i4a/pages/index.cfm?pageid=3537

In 2006, I made a formal declaration of my wishes on how I am going to die.  The other terms for this kind of document is “ advance directive” and “living will.”  I have been regularly updating my advance directive almost every year.

I have not have my living will notarized since 2006.  I felt it is NOT necessary.  I personally think, especially, in the context of my family environment, it is enough that my immediate and extended family members know that I have such a documented will and they know my wishes.

Advance directives will be of great help to my family members, physicians, and also to myself in decision-making during  my end-of-life stage.

Foremost, they will help me die with dignity and with shortest duration of agony.  They will also keep my hospitalization and medical expenses to just a “necessary “minimum.

In the past and at present, I have seen quite a number of patients and relatives suffering, physically, emotionally, and financially, that could have been minimized if not avoided by the presence of advance directives and end-of-life counseling by physicians.

In March 3, 2013, I updated my advance directive (see https://rojosonfacebooknotes.wordpress.com/2013/03/03/rojosons-tpor-on-advance-directive-2013)

In March 25, 2017, I am updating again as follows:

Declaration or Advance Directive

I, Reynaldo O. Joson, residing at ________________, being of sound mind, willfully and voluntarily make this Declaration:

(1) If the situation occurs that I am in a vegetative state or coma from an incurable disease process or injury (as determined by two physicians approved by my wife [___________] or designated successor attorney-in-fact), I desire and direct that life-sustaining procedures and means be withheld or withdrawn, including assisted respiratory ventilation and/or artificially administered fluids or nutrition (intravenous, gastric, jejunal, or other tube feedings), and that I be permitted to die naturally.

(2) If I should develop severe mental impairment to the degree that I am totally unable to perform activities of daily living or at least to recognize and meaningfully communicate with my family and others (as determined by two physicians approved by my wife [___________] or designated successor attorney-in-fact), I do not want intensive or prolonged hospitalizations, major surgery, artificially administered fluids or nutrition (intravenous, gastric jejunal, or other tube feedings), blood transfusions, or assisted ventilation.

(3) If the circumstance occurs that I am in a state of near-death, but a good possibility exists of recovery to a purposeful situation (such as my being able to write or otherwise communicate helpful thoughts and information to my family and others), then I do not restrict my physicians from exercising their skills with prudence, wisdom, and restraint.

However, I do not desire extreme measures such as a heart transplant or the implantation of an artificial heart (other than the use of a temporary bypass pump during surgery). And, if the state of near-death is part of a terminal cancer or other progressively incurable disease process or injury, then I desire that measures be directed at comfort, rather than to delay the moment of death.

(4) Furthermore, if I am in a vegetative state or coma from an incurable disease process or injury, or in a state of near-death with a progressively incurable disease or injury, or if I have developed severe mental impairment to the degree that I am totally unable to perform activities of daily living or at least to recognize and meaningfully communicate with my family and others (as determined by two physicians approved by my wife [______________] or designated successor attorney-in-fact), and if my heart or lungs cease to function, I do not want to be brought back to life with medications or with electrical or mechanical resuscitation or ventilation, or even with ordinary cardiopulmonary resuscitation.

(5) In any of these circumstances, it is my desire to be made comfortable with medications that are used to control pain, knowing that such medications may unintentionally hasten death. However, medications should not be used with the intention of causing death.

(6) It is my desire that the costs of my terminal care be kept to a minimum. Therefore, unless there are compelling reasons to the contrary, I would prefer to spend my last days at home rather than in a hospital or other expensive medical facility – unless being at home would be an unreasonable burden on my family.

I am legally competent to make this Declaration, and I understand its full import.

Witness my hand, this 25th day of March, 2017.

Reynaldo O. Joson, MD (Sgd)

March 25, 2017

xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx

In 2013, I came across “5 Wishes” which I added to my current advance directive. These will be applicable in 2017.

Five Wishes is a document that, like other advance directives, makes your wishes known ahead of time. It is unique among other advance directives, however, because it addresses all of a persons needs: medical, personal, emotional, and spiritual.

According to Aging with Dignity (http://www.agingwithdignity.org) the organization that created Five Wishes, the document lets your family and health care providers know:

  1. Which person you want to make health care decisions for you when you can’t make them.
  2. The kind of medical treatment you want or don’t want.
  3. How comfortable you want to be.
  4. How you want people to treat you.
  5. What you want your loved ones to know.

Below are my 5 wishes (2017).

WISH 1

The Person I Want To Make Health Care Decisions For Me When I Can’t Make Them For Myself.

1. First Choice: My wife

2 Second Choice: Consensus of my son and daughter

+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

WISH 2

My Wish For The Kind Of Medical Treatment I Want Or Don’t Want.

I believe that my life is precious and I deserve to be treated with dignity. When the time comes that I am very sick and am not able to speak for myself, I want the following wishes, and any other directions I have given to my Health Care Agent, to be respected and followed.

What You Should Keep In Mind As My Caregiver

• I do not want to be in pain. I want my doctor to give me enough medicine to relieve my pain, even if that means that I will be drowsy or sleep more than I would otherwise.

• I want to be offered food and fluids by mouth.

Life-support treatment

Close to death:

I do not want life-support treatment. If it has been started, I want it stopped.

In A Coma And Not Expected To Wake Up Or Recover:

I do not want life-support treatment. If it has been started, I want it stopped.

Permanent And Severe Brain Damage And Not Expected To Recover:

I do not want life-support treatment. If it has been started, I want it stopped.

In Another Condition Under Which I Do Not Wish To Be Kept Alive:

Advanced cancer, stroke, and other severe disability and terminally-ill diseases

++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

WISH 3

My Wish For How Comfortable I Want To Be.

• I do not want to be in pain. I want my doctor to give me enough medicine to relieve my pain, even if that means I will be drowsy or sleep more than I would otherwise.

• If I show signs of depression, nausea, shortness of breath, or hallucinations, I want my care givers to do whatever they can to help me.

• I want my lips and mouth kept moist to stop dryness.

• I wish to have warm baths often. I wish to be kept fresh and clean at all times.

• I wish to be massaged as often as I can be.

• I wish to have my favorite music played when possible until my time of death.

• I wish to have personal care like shaving, nail clipping, hair brushing, and teeth brushing, as long as they do not cause me pain or discomfort.

• I wish to have religious readings and well-loved poems read aloud when I am near death.

+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

WISH 4

My Wish For How I Want People To Treat Me.

• I wish to have people (my family members) with me when possible. I want someone to be with me when it seems that death may come at any time.

• I wish to have my hand held and to be talked to when possible, even if I don’t seem to respond to the voice or touch of others.

• I wish to be cared for with kindness and cheerfulness, and not sadness.

• I wish to have pictures of my loved ones in my room, near my bed.

• If I am not able to control my bowel or bladder functions, I wish for my clothes and bed linens to be kept clean, and for them to be changed as soon as they can be if they have been soiled.

• I want to die in my home, if that can be done.

++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

WISH 5

My Wish For What I Want My Loved Ones To Know.

• I wish to have my family and friends know that I love them.

• I wish to be forgiven for the times I have hurt my family, friends, and others.

• I wish to have my family, friends and others know that I forgive them for when they may have hurt me in my life.

• I wish for my family and friends to know that I do not fear death itself. I think it is not the end, but a new beginning for me.

• I wish for all of my family members to make peace with each other before my death, if they can.

• I wish for my family and friends to think about what I was like before I became seriously ill. I want them to remember me in this way after my death.

• I wish for my family and friends and caregivers to respect my wishes even if they don’t agree with them.

• I wish for my family and friends to look at my dying as a time of personal growth for everyone, including me. This will help me live a meaningful life in my final days.

• I wish for my family and friends to get counseling if they have trouble with my death. I want memories of my life to give them joy and not sorrow.

• After my death, I would like my body to be cremated.

• My remains should be put in Manila Memorial Park.

• The following persons know my funeral wishes: My wife, my son, and my daughter.

• If anyone asks how I want to be remembered, please say the following about me:

To my family –

Good husband –

  • Responsible
  • Loving
  • Faithful
  • Provide material needs
  • Provide emotional needs
  • Support wife’s emotional needs
  • Promote wife as a human being (rights)

Good father –

  • Provide companionship
  • Serve as a role model

Good man –

  • Man for family
  • Man for others

To my acquaintances –

Good man

Man for family

Responsible father

  • Provide
  • Support
  • Promote children as human beings
  • Provide companionship
  • Serve as role model

Man for others

Vision-mission

  • For himself
  • For his family
  • For his community

• Epitaph on my tombstone: Good Husband, Father, Man, Physician, and Teacher (with my picture on tombstone)

• I don’t like memorial services.

• I can have a wake for not more than 3 days.  In my wake, I like to have favorite songs played continuously and my autobiography shown (how I have lived my life).

• I will donate organs from my body that are “donatable.”

Reynaldo O. Joson (Sgd)

March 25, 2017

 

ROJ@17mar25

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