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Rogue Valley Doctor Says The Pandemic Highlights The Need For End-Of-Life Conversations

Image of seniors holding hands

COVID-19 is especially deadly for elderly people or those who have underlying health conditions. This can put doctors in the position of making decisions that might not be what patients or their families want.

John Forsyth is a retired cardiologist in the Rogue Valley and a past member of medical ethics committees at both Asante and Providence hospitals. Forsyth thinks this is an important time for people to make their end-of-life wishes known through something called an “advance directive.”

He spoke with JPR’s Erik Neumann.

Erik Neumann: In really basic terms, what is an advanced directive?

John Forsyth: Well, an advanced directive is often called a “living will.” It's simply a declaration of a person's personal preferences about the kind of care they would like to receive as they approach the end of their life.

EN: Why is now, while we're in the middle of the coronavirus pandemic, a more important time to think about an advance directive then other times might be?

JF: I think there are several reasons. First of all, obviously, we're in the midst of the greatest epidemic in modern history, one which especially threatens the lives and the health of frail elderly people; those who have other illnesses. Those folks are at very high risk of getting the illness and, if they do get it, of dying with it.

EN: I guess I'm trying to understand, what's the scenario at a hospital that you're trying to prevent from happening by having somebody fill one of these forms out?

JF: It's the scenario that's playing out thousands of times every day across our country in emergency rooms. A frail elderly person, often with other advanced illnesses, develops the coronavirus and arrives in an emergency room in crisis, unable to communicate and in great respiratory distress. That situation, if it's going to be treated in any way, requires a decision be made quickly with respect to the use of a breathing tube, a respirator, and committed to intensive care.

Without prior conversations and advance directive, a family – a loving family – often chooses the intensive care route. That commits the loved one to die in an intensive care unit a few days later, often in isolation and in discomfort. That's the very scenario that 70% of frail Oregonians have decided they wish to avoid.

With an advanced directive designating comfort care only, the decision becomes much easier for all involved: the person, the family, the caregivers. The person is made comfortable and within a few hours oftentimes will die with hospice support and in the presence of their loved ones.

That scenario is why my wife and I recently changed our advance directive to indicate that if we develop coronavirus pneumonia, we do not wish to be hospitalized in intensive care, but we would very much desire to have hospice care at home.

EN: And those ethical [decisions] in the hospital are things that doctors all over the country right now are having to make themselves when this information isn't available, right?

JF: That's absolutely right. It is a crisis situation. That decision must be made quickly, and they end up responding with the most aggressive therapy that they have available.

EN: It seems like you see this as sort of taking control of the end of your life, [which] can be more positive than the alternative?

JF: That's absolutely true. And it stimulates conversation with one's loved ones about what matters most in this person's life. Those conversations, as one approaches the end of life, are oftentimes meaningful and carry just a marvelous sense of peacefulness and resignation.

This interview has been edited for clarity.

Erik Neumann is JPR's news director. He earned a master's degree from the UC Berkeley Graduate School of Journalism and joined JPR as a reporter in 2019 after working at NPR member station KUER in Salt Lake City.