The conversation that’s an essential Mother’s Day gift

By John Mihalevich, M.D., FACP Chairman, Advisory Board – Respecting Choices of the Ozarks

If your mother could not speak for herself during a medical emergency, would you be able to communicate her wishes for medical care? Perhaps one of the best gifts to give this Mother’s Day is a a friendly ear and the encouragement to discuss end-of-life planning.

Dr. John Mihalevich, a retired Internist and advisory board chairman for Respecting Choices of the Ozarks advisory board, has seen first-hand the need for advance care planning.

He has witnessed the following scenario in different forms on many occasions. A 65-year-old mother arrived in the emergency room by ambulance in a comatose state. Family members arrived later and told the hospital staff the patient had high blood pressure and diabetes. Testing revealed the patient had suffered a stroke. She was admitted to the intensive care unit and in the following days she did not improve. The neurologist determined she would likely never recover. Stunned, family members discussed next steps. Their mother did not have an advance directive to guide medical care decisions. And their kids had never asked her to talk about her wishes.

Would their mom want to be kept alive by any means possible or would she rather forego any life sustaining interventions and die in peace?

Family disputes arose with some members advocating one option and some members advocating the other. In the meantime, hospital staff provided care to keep her alive even though she was declining. Their mother eventually needed a feeding tube to receive nutrition and a ventilator to breathe. Ultimately, her kidneys failed and she died.

The family was left divided and angry with each other and the hospital caregivers were saddened by this unnecessary outcome.

Please do not let this happen to you or your loved ones.

Many emergency department physicians, ICU nurses and physicians have experienced situations in which patients with life threatening conditions are unable to make decisions on their own. And this is not just an issue for older adults. A teenager in a motor vehicle accident with severe neurologic injury needs to have his or her wishes documented.

It is very important to have an advance directive in place to prevent the distressing situations described above. That is why several years ago Hospice Foundation of the Ozarks awarded a grant to bring Respecting Choices to Springfield, Mo. Respecting Choices is an international program for developing community-wide advance directives. It is based on five promises:

  1. We will initiate the conversation.
  2. We will provide assistance with Advance Care Planning.
  3. We will make sure plans are clear.
  4. We will maintain and retrieve plans.
  5. We will appropriately follow plans.

Respecting Choices of the Ozarks is a community coalition involving CoxHealth, Mercy, Jordan Valley Community Health Center, and Burrell Behavioral Health Center. Visit the Respecting Choices of the Ozarks page on Facebook for timely articles on advance care planning and contact details.