Thread by @stewartbrand

Errand done. (I'm in excellent health currently.)

Here's my Medical Directive for the Covid-19 situation. Now signed and notarized.

(Sources and full text will follow in this thread, for anyone interested.)

The note is addressed to my designated Medical Advocates, Alexander Rose and Ryan Phelan @Ryanphelan6--my hospice-trained wife who has 25 years in the healthcare biz.

My note is near-identical to the one she wrote, after she gave it much thought and research.

The text of Ryan's note is derived directly from one about dementia in Katy Butler's excellent book, THE ART OF DYING WELL, p 127. (Ryan checked her version with Katy.)

Here's the text of mine...

STEWART BURROWS BRAND

April 9, 2020

Dear Ryan and Alexander:

You're reading this because I am concerned, given the COVID-19 pandemic, that a time may come when I may not be able to make my own medical decisions.

As a human being in his 80s who currently has the moral and intellectual capacity to make my own decisions, I want you to know that I care about the emotional, financial, and practical burdens that recovering from COVID-19 would likely place on me and those who love me.

As my medical advocates, please understand I do not wish to prolong my living or dying if it means going on a ventilator.

So please let my wishes as stated below guide you.

•If I am seriously ill from COVID-19, I understand that a visit to a medical center, hospital or emergency room may be able to provide some pain relief, pharmaceutical treatments, and oxygen support (through nasal cannula)...

...that could ease my suffering and increase my chance of survival. I would welcome that.

•If the same services can be provided at home, with guidance through telemedicine, I would prefer it.

•Do keep me out of physical pain, with opioids as necessary.

•Do not agree to any tests whose results would be meaningless, given my desire to avoid treatments that might be burdensome, agitating, painful, or prolonging of my life or death.

•Ask for a doctor's order making me "DNR" (Do Not Resuscitate) and "DNI" (Do Not Intubate) upon my arrival.

•Ask my doctor to fill out the medical orders known as POLST (Physician Orders for Life-Sustaining Treatment) or MOLST (Medical Orders for Life-Sustaining Treatment) to confirm the wishes I've expressed below:

WHAT I DO NOT WANT is for a visit to the ER or hospitalization to escalate into a stay in an ICU without my requests below being carried out.

If my condition deteriorates to the point where doctors are recommending I be moved to an ICU for ventilation:

•Do not allow any attempt at ventilation or resuscitation.

•Please ask my medical team to provide Comfort Care Only.

•Ask my doctor to sign a do-not ventilate order and a do-not-resuscitate order, if this has not already been done.

•Try to secure hospice and /or palliative care for home support in dying.

•If not, please ask I be moved to a "comfort suite" or hospice unit.

• I wish to remove all barriers to a natural, peaceful, and timely death.

Thank you for taking good care of me,

--Stewart

___________________________________
Signature, Stewart Burrows Brand

Date________________

Location Signed___________________________

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