Allow Natural Death and other Advance Directives

The first block of medical school has passed quickly, and left me in a better place to find and understand scientific literature. Our second block is centered around anatomy and physiology and will include the complete dissection of a dead person. I feel well prepared to undertake this exploration of structure and function in part due to the recent exploration in a small group setting of palliative care and end of life treatment options.

As an EMT, I was already familiar with DNR (Do Not Resuscitate) orders that any person may prepare in case of cardiac or respiratory arrest in order to instruct health care personnel what measures should be taken. I did not realize that a patient's right to refuse extreme resuscitation efforts had only been protected legally since 1991, with the Patient Self-Determination Act. 

Then there are some states that recognize living wills and health care power of attorney (health care proxy). Thus if you are left incapacitated, your power of attorney can make all medical decisions for you. This is much safer because it does not allow the "crazy aunt from California" to fly in and demand that you be put back on the ventilator.

Finally, there are state specific documents that allow thy will be done even when you are unconscious. In NY, this thing is called MOLST (Medical Orders for Life-Sustaining Treatment). This document details your orders to physicians in various situations.

1. No pulse and/or Is Not Breathing

2. Patient has a Pulse and the Patient is Breathing

For situation #1, you can choose CPR or not.

For situation #2, you can choose 

a. comfort measures only

b. limited medical interventions

c. no limitations

For #2, you can also mark your preferences for 

a. intubation

b. hospitalization

c. artificially administered fluids and nutrition

d. antibiotics

e. other instructions

Other end of life decisions include organ donation or getting an advance directive in your medical record by having your physician note it down. It seems that the most effective way to ensure that your end of life wishes are met is to fill out as much legal paperwork as possible, and appoint a health care power of attorney to somebody who you really trust to follow your directions.

And this leads finally to the anatomical gift program and my sincere gratitude to the individual who has gifted his body to be my first patient and individual tutor on the inner structure of man.