Your Life's Choice

Welcome to the course!

Your Life's Choice course compliments the book You're Life's Choice by Dr Pagan-Carlo. You will be guided, step-by-step, by Dr. Pagan-Carlo.

You should first read the book — or at least the chapter that coincides with the course chapter — before watching each video.

Then, ss you follow along with Dr. Pagan-Carlo, he will explain things in greater detail and help you answer the questions at the end of each chapter.

By the time you reach the end of the book and course, you will have all of the information needed to create your Advance Healthcare Directive, which you can then bring to your attorney for a final review. 

The Last Say and How to Start Making the Plan

Key Points: Chapter 2

Medical crises become pivotal points (forks on the road) in the journey of our lives. In times of crisis, if we have not made our choices known, we suffer the consequences of our own indecision and may lose control of our options.

Do not wait until the crisis to decide.

Statistics: Out-of-hospital cardiac arrest mortality and in-hospital cardiac arrest mortality are approximately 87% and 75%, respectively. For patients more than 80 years old, out-of-hospital cardiac arrest mortality is 96%, and in-hospital cardiac arrest mortality is 88%.

Successful rescue from a medical arrest depends on a multitude of factors, many of which are out of your control. In other words, surviving a cardiac arrest doesn’t ensure you will be the same person you were before the event.

To start addressing your end-of-life wishes, think about what your personal QOL markers are (see Table 1), and after the loss of a certain number of them, will your life no longer be enjoyable and/or become a burden? For example, if you enjoy reading, the loss of vision may be compensated for by listening to stories or audiobooks. But if you lose both your hearing and your vision, is what’s left of your life enjoyable or burdensome?

Key Points: Chapter 3 

What causes our end-of-life inertia?

Fear and anxiety over making the wrong choice

Lack of awareness

Intimidation of health care

Being overwhelmed by the number and difficulty of tasks

Lack of time

Procrastination

Religious or cultural beliefs

We must accept death as a feature of life, just as childhood and adolescence, and not as a failure of life.

It is more important to talk to others about your wishes than to write down specific options for clinical scenarios. But if you know there are certain procedures or life-saving techniques you do not want to be put through, write them down and communicate your wishes clearly. We’ll talk more about this in later chapters. 

Key Points: Chapter 4

“Death used to be a spiritual ordeal; now it’s a technological flailing”

—Katy Butler

There will come a time when we can no longer “beat this thing”—the disease. And unfortunately, technology can give us “false hope” and leave us stuck in the denial stage of grief instead of letting us progress through all the stages of grief. 

Health care can be an expensive labyrinth that is difficult to navigate and endure.

One of the best ways to prepare yourself for making end-of-life decisions is to expand and improve your health/medical literacy.

It is important for the person dying to settle relationships, pass on wisdom, share memories and mementos, and make peace with God.

Key Points: Chapter 5

Damar Hamlin, the football player and safety for the Buffalo Bills, was promptly rescued, given CPR, and transferred to ICU. He will likely do very well long term.

All the life-saving techniques discussed in this chapter are safe and effective. But they also do carry a small chance of certain risks.

The technology options available to you in a medical emergency include CPR, AED deployment, ACLS, IV support, pacemaker, hemodynamic support, and the ICU.

Key Points: Chapter 6

Palliative care and hospice are both specialized care options that consist of an interdisciplinary team of medical professionals and utilize a number of services to provide comfort and support for patients diagnosed with a serious illness.

Palliative care and hospice both aim to provide pain, symptom, and stress relief as well as a holistic approach that supports the patient’s physical, mental, emotional, social, and spiritual needs.

Palliative care can begin at any time and may last as long as the patient needs it. The goal is usually to continue pursuing primary curative treatments in addition to receiving pain and symptom management.

Hospice is reserved for patients who have been given six months or less to live. It typically forgoes curative treatments and includes all the services provided by general palliative care plus others, such as advance planning and bereavement support.

Key Points: Chapter 7

Your legal kit consists of your advanced health care directives, which includes a living will (concerning terminal conditions) and a health care POA.

Key points to address in your ACHD are your wishes to receive or decline CPR/mechanical ventilation, dialysis, tube feedings, use of IV medications and IV fluids, and comfort care. You need to be specific and clear about what you would or would not like.

If you are unable and/or unwilling to make a choice or never made your wishes known ahead of time, things can get complicated quickly. Loved ones can disagree amongst themselves, and decisions might get dragged on unnecessarily and even into court, sometimes at considerable costs.

Have copies of documents easily accessible for emergency medical services.

Simplicity and clarity of your documents are key. A document that is difficult to interpret is practically useless. Elegant solutions to any problem are always simple.

Key Points: Chapter 8

Choose a POA/proxy who understands your wishes and is willing to have as many conversations as needed until you are satisfied that they understand what you want from them.

Choose someone who is comfortable making decisions for you.

Make sure your POA/proxy does not have a conflict and/or wants you dead.

If your proxy is not a family member, make sure your family and spouse understand why you made such a decision. It does not have to feel for them as if you are betraying them.

You can change your proxy as often as you need to or like to as long as all the legal forms are filled and filed appropriately.

Your POA has to be someone you trust with your life and your death.

Key Points: Chapter 9

“It always seems too soon, until it’s too late.”

Friends and family play key roles in helping you with your end-of-life options.

Have lots of conversations and reinforce your wishes.

Be clear on what matters to you and be clear on your choices.

Start the conversation and keep it going with all those who will be affected by your death.

In this section, you will transfer the answers from the questions at the end of each previous chapter. Each question has four-character identification (and one more letter if there are subquestions—for example, 1Q05 a). The first character represents the chapter number, then a Q for the question, and the number (05). For example, 9Q04 means chapter nine, question four.

In each of the following sections, you will transfer your answers to the corresponding question according to the number of the question. Please note that the question order in each section may not be sequential.

The four sections are Section A: Overall and Philosophical Approach to End of Life, Section B: Questions Regarding Your Health, Section C: Questions Regarding Your Power of Attorney (POA), and Section D: Basic Advance Health Care Directive (AHCD).

In Sections C and D, there are blanks so you can fill in your POA and alternate POA, as well as anything else you may want to include in your AHCD. If you have not been able to answer all the questions, go back to each question, read the key points of the chapter, and attempt to answer the question. The point of this exercise is to make choices and have a basic AHCD so you can start addressing your wishes for the end of life. Ask your family, friends, and doctors their opinion on anything you do not understand.

KEY POINT 1: Few people have cardiac or respiratory arrest unless they are sick.

KEY POINT 2: This exercise is for individuals with medical issues—some manageable and some potentially life-threatening—who are starting to come to terms with their own health issues and mortality.

KEY POINT 3: If you are young (less than 40 years old) and have no life-threatening condition, your chances of a great outcome after a witnessed cardiac arrest are great. Think of Damar Hamlin. He had CPR (urgent heart and lung aid), probably defibrillation (reviving heart through electric pulse) and intubation (breathing tube insertion), and was in Intensive Care Unit(ICU) for a couple of days. He has fully recovered.

KEY POINT 4: If you are using dialysis as a bridge to transplant, this section is not for you (1).