Advance Care Directives in the Emergency Room [Interview][Transcript]

Dr_Kevin_Haselhorst_Advance_Care_DirectivesGuest: Dr. Kevin Haselhorst
Presenter: Neal Howard
Guest Bio: Dr. Haselhorst is an emergency medicine physician in Phoenix and the author of “Wishes to Die For,” an introspective guide to advance care planning. His views began to change after conversations with patients pinpointed the need to create smoother transitions, offering peace of mind for families coping with incurable illness.

Segment overview: Dr. Kevin Haselhorst, MD, an ER doctor, and author of WISHES TO DIE FOR, discusses the role of Advance Care Directives in the emergency room setting, and describes the Universal Healthcare Directives.

Transcription

Health Professional Radio – Advance Care Directives

Neal Howard: Hello you’re listening to Health Professional Radio. I’m your host Neal Howard, thank you so much for joining us today. Everyone of us is going to face the end of life, it’s something we lived with each and every day. Our guest in studio today is versed in end of life care direction and preparation. Dr. Kevin Haselhorst is an ER Doctor practicing in Phoenix and the author of “Wishes to Die For,” an introspective guide to advance care planning. And especially as it focuses on the ER. How are you doing today Kevin?

Dr. Kevin Haselhorst: I’m doing well Mr. Howard.

N: As an ER doctor, I’m sure that many of us have that experience with the ER. But when it comes to the fast paced day to day thing that go on in the ER from what we’re told, where does the time in to talk about the end of life because not all situations in the ER end up as end of life situations?

H: That’s very true. But you know there are breaking moments in any conversation where you stop, the wheels of time stop and you will have to take a moment. And you have to engage a person in a much deeper level, than say a broken arm or a cut or something like that.

N: Uh huh.

H: And because you seek out your priorities or whatever. And I prioritize people who are dealing with end stage disease as something that I’m connected to. Some people connect with little children, I connect with older adults particularly struggling with the end of life concerns. And particularly the caregiver who are engaged in that same conversation, and at wit’s end trying to figure out what to do.

N: Now we hear a lot about advance care directives, having a living will and some type of preparation just in case something happens, something in place or we should have something in place with directions for those of us that we’re going to leave behind that are considering these issues. What role that these advance care directives play in the ER?

H: I believe they play a very little role because most of the time we act before we’re able to think. So to be able to find the advance care directive as to what the person may or may not want given their situation. Some of it is understood automatically, if you’re 45 years old and you collapse and you have a heart attack you’re gonna CPR. I don’t care what your advance care directives says, it doesn’t apply in that moment. So there is a fine line where it actually takes hold and mostly regarding persons who are in from, perhaps a nursing home or elderly population who have DNR’s that prefer “not to be resuscitated.” But ideally, they’ve already, we’ve known that, it’s already communicated ahead of time. So even having the advance care directive is already been sort of attached to them when they came to the emergency room. But I think there is very little value for them in the heat of the moment, I think after they’re more up to fact when you’re left in persistent vegetative state as to how much kidney dialysis do you want to have if you’re in a coma.

N: So advance care directives, they’re kind of specific if I’m understanding them correctly whereas a universal healthcare directive is more general and there is more wiggle room. Is that a correct statement or do I need to be educated?

H: I think the universal healthcare directive gives a whole template to the notion of how we lived the circle of life. There is a time to live, there is a time to survive, and then there is a time to die. And infused in that senses this idea faith hope and love, that you have this sense of where in faith really serves you in the beginning of life. Faith doesn’t serve you at the end of life, love serves you primarily. And putting those in a context in the diagram in the book, gives a whole clear message about when it’s time to leave your preventing illness, when you’re in end stage disease, you’re being very conservative in your treatment because you know being aggressive doesn’t make sense to put somebody end stage disease in the intensive care unit. We all see the mistakes that go wrong when we try to do too much. And we haven’t really understood that there is appropriate care given to each part of our life. And that is not appropriate for people to die in the intensive care unit when they’re struggling with terminal cancer. That there is something misguided about that and part of it is our own confusion and our own this ease with a whole aspect of letting somebody go. But clearly a time to die is a time to let people go.

N: Now the title “Wishes to Die For” implies what should your wishes be, or how should your wishes should be considered when you die.

H: Well the context, the book is written for the people in their middle age to have a sense of their priorities and values. And I’ve really want people in the prime of their life to take a look inside and see what’s most important to them – is it family? Is it finances? Is it your spirituality? Is it personal responsibility? Is it personal freedom? What resonates most with you because when that’ taken away from, you get a chance you’re allowed to die. You don’t have to continue to live indefinitely when your quality of life ends. But we draw up these general words put in to you label it, you don’t know when your quality ends. If you haven’t labeled your quality of life as being the ability to go to Starbucks or give me liberty or give me death – they’re very clear statements that resonate with people if they and it should empower people to say “Yes, if I don’t have this then it’s time for me to, then I’m ready to die. Well if I die this moment I would be the happiest person alive.”

N: So the book is more about preparing yourself mentally, spiritually, and I guess rationally for the inevitable?

H: Yeah, again it goes back to your priorities. I see the advance care directive as a spiritual document and not so much as a medical legal document. Because if we’re really talking about what matters to people, what we’re connected to spiritually matters to us more than what the physical world leaves us with.

N: Let’s talk about your book and the feedback that you’ve received from others in the medical community, others specialists, other ER doctors and nurses – how they’ve reacted to the book.

H: Well I’ve become the adviser. I get a lot of positive support from nursing and from other physicians who say “How should I handle this or well what would you done in this situation?” And I think I’m giving them permission to pull back from some of the standard of care of how we just cookbook everybody in terms of how we treat people. And taking a step back and saying “Is this how we would want to be treated?” And creating less fear around them, the legal implications of not doing things at the end of life. If you have an open communication with family, you don’t have to worry about the legal repercussions. There is nothing wrong about people dying. And yet we still have that fear that if the person died, we did something wrong.

N: You’ve been listening to Health Professional Radio, I’m your host Neal Howard talking with Dr. Kevin Haselhorst. An ER doctor who’s also the author of “Wishes to Die For” which is an introspective guide to advance care planning from a spiritual, mental and relationship point of view not so much as a legal document or talking about financial planning. It’s been great having you here with us today Kevin.

H: Thanks Neal.

N: Transcript and audio of this program are available at healthprofessionalradio.com.au and also at hpr.com and you can subscribe to our podcast on iTunes.