By Jeanette Leonard Fridley,
To Whom It May Concern:
My name is Jeannette Fridley, RN. I am writing to you today because I am trying to enlighten the public about some very disturbing practices that violate basic human rights and bog our Medicare and Medicaid system down. I have been a nurse for 27 years and I have had numerous opportunities to confirm my observation of the health care system.
First, I would like to mention our senior citizens, the use of advance directives and the assignment of a Power of Attorney. While a patient is in good health, they can make their future health care preferences known by making an advance directive for health care and assigning a Power of Attorney.
Far too often, it has been my observation that most people will appointment a family member as Power of Attorney. Often, due to immense grief and stress, the Power of Attorney is not able to carry out the patient’s health care wishes when the patient themselves are not capable of doing so. Many times in their state of grief, facing the fear that their loved one may pass away, the Power of Attorney changes the ‘Do Not Resuscitate’ order and makes the patient a full resuscitation.
This means that a patient who, in writing, wished to not receive artificial life preservation can now be kept on life support indefinitely because their Power of Attorney wishes it so. The patient that did not want to have artificial life support may have to go through countless rounds of painful procedures to stop the natural process of death. These include having the heart restarted, placing Endotracheal Tubes within the lungs, being placed on a ventilator, and extensive surgeries.
I am an Intensive Care Unit nurse and I have responded to many of these Artificial Resuscitations on patients who have already declared their wishes for a natural death. Very often during normal compressions, ribs and sternum may break during because of osteoporosis of the bones. One of the most unfortunate consequences of this type of resuscitation is that medical professionals do not know if the patients has had brain damage due to lack of oxygen before the code is called. This means that we may be “saving” a patient that is already cognitively dead. If the patient is successfully resuscitated, they are then placed on a ventilator, being in its own right painful and extremely invasive.
Most often, the patient will resist the ventilator and have to have their wrists restrained. In addition, the may have to be medicated with Propofol, which induces a temporary coma-like state to sedate the patient while on ventilation.
Propofol is very costly and can damage the liver. Very often the elderly have respiratory issues such as Chronic Obstructive Pulmonary Disease, emphysema or black lung disease, and therefore; they can never be “weaned off the ventilator”. A ventilator patient will have to endure a daily routine of a chest X-ray, a very painful arterial blood gas, and daily routine lab work.
Similarly, the patient must have artificial nourishment, so medical professionals place a tube down the patient’s nose, which causes extreme pain, and the start tube feed. More often than not, the tube feed causes diarrhea, which then leads to skin breakdown and wounds. This is only the beginning. They will be transferred to a skilled nursing facility that is short staffed and at best, they receive subpar care. Before a long term acute care facility or nursing home will accept the patient, the patient will have to have a Tracheostomy, or an opening in the throat, to connect the ventilator to and a tube that is surgically placed in their abdomen, so the patient can received tube feed. Because the patient is still a full code, they may have to be resuscitated again during this time. This is a violation of their rights, as they did not choose this type of care.
An additional concern is the high daily cost of ventilator-capable nursing homes. The Medicare system is being drained by keeping the same patients who have signed advanced health care directives on ventilators in nursing homes, despite the fact that they did not choose this type of healthcare and do not have a chance at favorable outcomes.
An alternative option to these unwarranted, costly, inhumane practices is the Hospice service, which is more affordable, more comfortable, and more in line with these with the wishes of patients with ‘Do Not Resuscitate’ advance directives. Patients are able to choose a facility or their own home after which they choose not to receive any more medical procedure, but instead being kept comfortable with the aids of pain medication and family support. This means patients die with dignity and respect in their own environment with those they love surrounding them. This is the most natural option for those patients who do not wish to receive artificial resuscitation.
Finally, ignoring the final wishes of a patient can have devastating financial consequences for surviving spouses. If an adult child is deemed Power of Attorney, this adult child can choose to change the health care preferences of their dying mother or father. In fear of death, the Power of Attorney chooses to artificially prolong the life on the parent for years and even decades. Although the son or daughter had no authority to make this decision, the surviving spouse is left with the hospital bills. This can lead to fiscal hardships for the already struggling senior spouse, or even bankruptcy.
Without taking steps to change these kinds of injustices, both the Medicare system and families will continue facing financial burden, not to mention the violation of dignity and respect to patients who have already made their wishes clear. One way to solve this problem is to have a Federal Advanced Directives Registration, in which health care preferences follow patients from facility to facility. In addition, legislation must be passed in order to make the written, notarized final wishes of patient’s legal and binding, unable to be changed by Power of Attorneys.
Finally, public education must be extensively available to the community, advocating for end of life care choices to be made and discussed with family members when patients are alert and in good health. Taking these steps to educate the public, as well as making sure intended wishes of patients are clear and followed through, is the most financially sound and humane option for Americans.