How Would You Feel About Being Put On A Ventilator?

If you contract COVID 19 and are hospitalized, what kinds of interventions do you want? 

According to a May 12, 2020 report from Kaiser Health News, one thing many older people definitely DON'T want is to be placed on a ventilator. To make sure their wishes are honored, they are revising their health care advance directives to reflect that preference, and making sure their designated health care surrogates are aware of it. While the pandemic has made people of all ages keenly aware of the need for health care documents, older people tend to feel a greater sense of urgency. They are more susceptible to infection, and more likely to experience severe symptoms and succumb.

When placed on mechanical ventilation, a tube is placed down the patient's throat (intubation). The patient is kept sedated and isolated in the ICU. No visitors are permitted. By now we've all heard first-hand accounts of patients who had this experience. They are thankful to be alive, but  traumatized by the days or weeks they spent intubated. Moreover, for an older person, intubation is less likely to save life. "Their prognosis is not great," says Dr. Douglas White, a professor of critical care medicine at the University of Pittsburgh. Additionally, older people generally spend more time on ventilators than younger ones, and if they survive, face a more grueling battle back to functionality.

Obviously, none of that precludes you from desiring and receiving mechanical ventilation. Each of us must assess what procedures are worth enduring for the chance to survive.

If you want to address your desires for intubation in your health care advance directives - because you wish to rule it out, or rule it in - contact us and we can assist you. Reach us at (561) 625-1100 or email KLF@karplaw.com. 

Importance of Advance Directives, End-Of-Life Wishes Reflected in Barbara Bush's Passing

Former First Lady Barbara Bush died at her Houston home on April 17, surrounded by her family. She had chronic obstructive pulmonary disease, heart failure, and had been hospitalized multiple times in recent weeks. Following an Easter weekend in the hospital, the 92-year-old decided to let nature take its course. She rejected additional life-prolonging measures, which likely would have included being attached to a breathing machine. The family announced her choice for "comfort care" only and supported her decision. She died with her husband of 73 years, President George Herbert Walker Bush, holding her hand.

The timing of her decision and passing has particular significance given that National Healthcare Decisions Day was April 16. Established in 2008, the purpose of NHDD is to encourage Americans to complete advance directives and to talk to their family about their healthcare wishes, including their end-of-life wishes. According to a 2013 survey by the Conversation Project, only 27% of Americans have done so -- even though 90% say it's very important!

Nathan Kottkamp created National Healthcare Decisions Day as a result of his experiences serving on hospital medical ethics boards. He writes on the NHDD website: "Time and time again, families, providers and health care administrators struggle to interpret the wishes of patients who never made their healthcare wishes known (or who failed to create an advance directive to record their states wishes.)" Kottkamp applauds the Bush family for going public with this most personal decision and hopes it will encourage others to create health care documents and to discuss these issues with family. And Ellen Goodman, chair of the Conversation Project, which provides tools for families to talk about these sensitive issues, said of Bush: "It sounds like this forthright, outspoken woman has made her wishes known and the family is standing by her."

Under Florida law, a competent adult has the right to make his/her own health care decisions. That includes the right to reject unwanted medical procedures. You also can name people to make your decisions if you are incapacitated and cannot do so yourself. Creating advance directives for healthcare can give you peace of mind and do the same for your family, making them confident they are doing what you want if they are called on to make decisions on your behalf.


Remember: It always seems like it's too early, until it's too late. There are several types of advance directives available to clients. Contact us for assistance. 

When advance directives are ignored

When we discuss end-of-life wishes with clients, some clients say they want everything possible done to keep them alive, regardless of their physical condition or possible outcome. If they can hang on for a while longer, they reason, there might be some medical advance around the corner that restores their health. If that is your inclination, you have every right to direct your health care providers to pull out all the stops.

On the other hand, you also have the right to reject extraordinary medical procedures that could result in what you consider an unacceptable quality of life. In my experience, that attitude is far more common. But disturbingly, according to an April 10, 2017 New York Times article, the right to refuse medical treatment is sometimes not honored, even when patients have made the appropriate legal preparations. The logic of many medical providers seems to be to err on the side of caution: After all, someone who has been resuscitated can be disconnected from life support, but you can't bring someone back from death. 

One instance mentioned in the article is that of Beatrice Weisman. In 2013, at age 83, Weisman was hospitalized after having a severe stroke. A resident of Maryland, she had a Physician's Order for Life Sustaining Treatment, or POLST. (POLST is under development in Florida but not yet available here. In states that do permit them, a seriously ill or frail patient or his/her health care surrogate may establish, in consultation with the individual's doctors, guidelines for the types of treatments the patient should or should not receive. The POLST is different from the advance directives now available in Florida because it is an actual physician's medical order, an official part of the patient's medical record.)

Weisman's POLST indicated she was not to receive CPR in the event of pulmonary or coronary failure. It was located in her medical chart at her bedside. Nonetheless, when hospital staff found her in bed turning blue, they rushed to save her. She was defibrillated and received epinephrine injections. Several of her ribs were broken during the administration of CPR. Weisman survived. After a few years of physical therapy and round-the-clock care - paid for out-of-pocket by her family - she remains bedbound, attached to a feeding tube and catheters, and suffering from dementia. The family has sued the hospital for keeping her alive against her express wishes. Says her son: "I'm happy to see my mother each day, but I'm also seeing her suffer each day."

As we live longer and longer, it is inevitable that more cases of this type will occur. The courts seem inclined to side with plaintiffs. For example, the Georgia Supreme Court recently rejected a hospital's claim of immunity, stating, "It is the will of the patient or her designated agent, and not the will of the health care provider, that controls."

Of course, being revived against one's wishes is not always a function of overeager doctors and hospital staff.  It is all too common for a healthy person to have a valid living will prepared, yet fail to notify his/her family or health care agent that it exists, or where it can be found. Many people just stick it in a file cabinet or lock it up in a bank vault, and forget about it. And once someone becomes cognitively incapacitated, he/she may not be able to tell others that the document even exists. 

Your best bet to ensure your end-of-life wishes are honored is to make sure your physicians, family, friends and health care agent know about your advance directives, where they are located, and how they can be accessed. Some suggest downloading the documents to your mobile phone and to your loved ones' mobile phones, too.

Read about the various types of Florida advance directives here.

Read the original New York Times article on this subject here.

Read about the POLST form, currently in the planning stages in Florida, here.