As we age, it is important to think about the kind of care we would or would not want at the end of our life. It becomes even more important during a pandemic. The people responding to you—be it your primary care provider, a family member or friend, a paramedic or an emergency room physician—all want to know: What kind of care do you want?
We know that Covid-19 can cause life-threatening illness relatively quickly, and that while most people have mild to moderate symptoms, many are sick enough to be hospitalized and need support from a ventilator. Those with health conditions like diabetes or hypertension who are over age 65 are particularly at risk. Many people who are severely ill on a ventilator require prolonged hospitalization under heavy sedation. If they are able to come off of the ventilator, they may have a long process of rehabilitation ahead of them. Many people who end up on a ventilator are unable to come off of it, and thus die.
It is the default mode of our medical system to do everything we can to support survival. Yet that is not always what someone would choose, if offered the choice.
We don’t how Covid-19 will make its way through West Marin compared to other communities. Now is a wonderful time to have conversations with loved ones and primary care providers about how much care you would you want, and in what setting. These are deeply personal considerations, and there are no right answers. For many people, myself included, it makes sense to opt into the full extent of life supportive treatment. For many, particularly if this care is unlikely to be unsuccessful, it could make more sense to opt for care in the hospital but stop short of being put into a medically induced coma on a ventilator. For some, it makes the most sense to focus on comfort care, or palliation, of symptoms at home, with the support of medicines that alleviate suffering.
How do you make these wishes known? Start with a conversation. Then fill out an advance medical directive. You can obtain one from your primary care provider, or online in English and Spanish at prepareforyourcare.org/advance-directive-state/ca. You can specify on the form if your wishes pertain only to Covid-19.
Dr. Anna O’Malley, M.D., is an integrative family and community medicine physician with the Coastal Health Alliance. She also founded and directs the Natura Institute for Ecology and Medicine in the Commonweal Garden, and is uploading resources at naturainstitute.org. She is holding Zoom calls each Wednesday from 6:30 to 7:30 p.m. to share up-to-date information and answer questions from a public health and integrative primary care perspective. RSVP to firstname.lastname@example.org for the call information.