Grown Children, Us and Covid-19: Updating Advanced Directives

                                             Romare Bearden Tomorrow I May Be Far Away

I am no longer a New Yorker but, in this time of coronavirus, I am a regular viewer of New York Governor Andrew Cuomo's daily press briefings. When he reports those stress-inducing intubation statistics, he reminds us that 80 percent of patients who are intubated and placed on a ventilator don't have what he calls "a good outcome." He doesn't spell it out but the data shows that those who survive the worst trials of Covid-19 may have continuing, life-altering struggles.

The decisions about what to do  if we were on the cusp of being intubated will fall into the laps of our children, spouses and siblings. A friend of mine's daughter-in-law who is a hospice doctor says she now spends a lot of her time counseling families who have to deal with these very difficult ventilator-related decisions.

Which brings me to this point: We may have left our children general guidance (advanced directives) about how we want to be treated if we can't make decisions for ourselves, but in the Age of Coronavirus they may need an update on what we want done for or not done to us. I  brought up this question briefly in a post that ran a few weeks ago. Since then a NYTimes article has been even more blunt, headlining its story: "Do You Want to Die in an I.C. U.? Pandemic Makes Question All too Real."

The article starts off with what a 69-year-old retired teacher told her son--her health care proxy--about whether or not to put her on a ventilator should she become ill with Covid-19. Her son, who happens to be president of the National Hospice and Palliative Care Organization, said his mother discussed her concerns with him. He was able to understand the pragmatism behind her directive. He knew what she would want him to do it worst came to worst. Beyond the particulars of his own situation, a point he made was this: “It’s the kind of conversation everyone should be having with their loved ones.”

The article also brings up an issue that, even if months or years ago we gave our children general Advanced Directives, there's one point that may not have been covered in that guidance:

When seniors and their families engage in what’s called advance-care planning, they often focus on the D.N.R. question — whether patients would want to be resuscitated after cardiac arrest.

But because Covid-19 is a respiratory disease, the more pressing question will likely be whether a hospitalized patient who’s seriously ill will accept intubation and ventilation.

It's never easy to discuss these kinds of issues with our children--they resist; neither they nor we are keen to deal with our mortality. We figure we'll talk about it 'one of these days.' But with coronavirus cases still on the rise in the U.S. and treatment more complicated and drastic than anyone imagined, that day may be here.