living bridge

Monday, April 22, 2013



      WILL   is a legal statement made by a healthy citizen detailing the disposal of his estate, material wealth 
LIVING WILL is a legal statement made by a healthy citizen detailing not about his wealth but the way he /she desires the way to be taken care, when he/she succumb to incurable illness and how far life supporting measures to carried forward. Such WILL is sure to ease the burden for the sons, daughters as well as doctors
Ever since I have come to know of living will it has been in my mind as to

 the value, significance and the necessity of such LIVING WILL.  I have

 operated many Patients with cancer esophagus.Most cases are followed up with Chemotherapy or/and radiotherapy to kill any residual disease or prevent  recurrence. Due to side effects of chemo/radiotherapy {loss of appetite, loss of weight, depressed bone marrow ,low white cells,anemia,hair loss etc  many patients decline to continue such therapy for the simple reason that the treatment is prolonged  for nearly three months. Post operative chemo/radiotherapy does indeed prolong the survival, improve the quality of life. But should such regime is to be insisted/forced on patients when they or the relatives  are not keen especially so when the patient is  above 70 years.

On occasions when the patients are on ventilatory support following a cardiac problem ,comatose patients , accident victims when the relatives are keen to know whether full ,complete recovery is possible and if so they don’t mind to continue the ventilatory support—whereas the attending doctor, justifiably so, say that he will do his best but  cannot and will not give a guarantee  about the out come. This sort of scenario is often encountered when the sons/daughters are living abroad and are keen to get back –not that they desire to abandon the parents.

The physicians while treating a disease the priority should be[Q.O.L.] quality of life after the chosen line of treatment. The most difficult problem the doctor  faces: whether to unmercifully prolong life with suffering in the face of  inevitable death.

The heroic measures ; the ventilatory support,tracheostomy, life supporting

 drugs to keep the patient alive in deep coma with multiorgan failure is

 indeed dysthanasia-  meaning resulting in painful, undignified death

 although the doctors and the relatives know the borrowed time is spent in

 misery for the patient as well as relatives with emotional and financial strain.
The relatives have mixed views whether to continue all measures or cut off the

 ventilator support. Some request the doctor to continue till the last breath to

 avoid retrospective regret. The medical fraternity is also obliged to continue

 for fear euthanasia.

In such circumstances when a LIVING WILL has been drafted by the elder, countersigned by the sons, daughters , notarized by a notary the decision under such situations  are made  easier not only for the relatives but also for the doctors 

HIPPOCRATES pledged physicians not to use drugs to produce death. He

 also forbade administration of remedies to those beyond hope.

Dr.Worcester wrote in his classical book THE CARE OF THE

 AGED,DYING, AND THE DEAD ‘‘Modern methods of resuscitation are

 most decidedly out of place whereby by disease or by accident the body’s

 usefulness has ended’ Especially is this true when resuscitation would only

 prolong the patient’s suffering. Such attempted defiance of nature is even less

 justifiable than are efforts to prolong life when the inevitable approach of

 death offers merciful release. Yet in both these ways many of our profession

 seem duty bound to do their utmost. They ought to know better. The dying

 ought to be allowed to depart in peace. For there is no treatment for death.

Pope Pius XII within the last year of his life stated the official position of the

 Roman Catholic Church as not requiring the physician to use extraordinary

 means when only certain death and suffering lies ahead. He also stated that

 with the consent of the dying person it is permissible to use narcotics in

 moderation to alleviate pain, suffering, even if the narcotics hasten death. In

 this case death is not directly desired but is inevitable.

Documentation and registration of LIVING WILL certainly ease pressures and responsibilities of the relatives as well as doctors

When the bill is enacted the response from the literate and the illiterate of Indian citizens remain to be seen. Is there any room for misuse?

Having said all that one might ask –What is my view and decision with regard to my life.

Before I pen my views I would like to narrate two incidents in my family when I have to take two completely different decisions.

1} My mother aged 68 yrs, known hypertensive was on irregular treatment.
One day she complained of severe headache, drooping of one eye lid which is a tell tale sign of P.COM aneurysm-surgeon performed D.S.A to localize the aneurysm—soon she became comatose possible because of internal bleed and was on life supporting ventilator and drugs. Late that night surgeon phoned and wanted my consent for emergency tracheotomy-discussed with my father, brother and even though the chances of recovery was negligible I gave a go ahead signal  for tracheotomy  for the simple reason I didn’t want any stone unturned and avoid retrospective  regret. Next day her soul departed leaving the mortal body behind

2} my father aged 83 yrs was loosing weight, appetite, and getting depressed. Ultrasound abdomen revealed multiple rounded shadows in the liver –possibly secondary metastasis. To confirm we have to biopsy the liver and extensively investigate to identify the primary. In my father’s case I declined to submit him to any investigations for I knew pinpointing the culprit and submitting to chemo/radiation will not improve the quality of life . His condition gradually worsened and his soul departed after a fortnight.

In both cases I feel that I have taken the right decision.

Based on my life experience I will make a LIVING WILL wherein I will state that when I fall sick and any therapy surgical/medical ,will in the opinion of doctors that it will improve my quality of life then I will abide by the decision of doctors. If on the other hand any life supporting measures will not improve the quality of life then I rather prefers to breathe my last peacefully thereby I don’t hold any one of my children responsible