The Tribune

By ALESHA CADET

Tribune Features Reporter

acadet@tribunemedia.net

IN A Country that is plagued with noncommunicable diseases and where many people die young, a local doctor is calling on people to recognize the importance of end of life care.

People in their 30s and 40s often do not look towards making living wills and other preparations, but Dr N’Tari Darville, clinical director at Doctors Hospital, is cautioning these persons to “make your wishes known before you get sick.”

Speaking about the importance of having advance directives and living wills, Dr Darville said the hospital’s common concern is “why don’t people think about end of life.”

“We are becoming more advanced in the Bahamas with health care equipment, and with medical treatment. One thing that hasn’t changed a lot is how long we live. Something we have been working on however is quality of life and giving patients and their families more autonomy, “ said Dr Darville.

Mr Darville said most times when patients come into the Intensive Care Unit (ICU) at the hospital, many times these persons have not made preparations or their families have not made preparations. He often wonders why.

“Why don’t we prepare for end of life?”
“My mother always said “you don’t talk about those things”, as if end of life care is going to bring death closer. Some people have these superstitions about it and some people just have fear of end of life. I don’t know which US president said it, but they said there are two things you are going to faced with: one is death and the other is taxes. But guess what, they are both applicable in the Bahamas as well, we face death and taxes,” said Dr Darville, which speaking at a Doctors Hospital lecture series.

Dr Darville said persons should spend more time addressing end of life issues, asking themselves “ how do I want my preparations to be?” He said at Doctor’s Hospital, their hopes are to put the patient in “the driver’s seat,” in terms of deciding what direction they want to go.
Hospital Legal Counsel, Michaela Sumner Budhi, said: “With the advances in technology that we are experiencing in the Bahamas, this means that we have the ability to postpone the inevitable, death, for a period of time. But for most of us, dying is a process and there are things that we need to take into consideration.”

“What efforts do we want to take to maintain a patient’s life, even if it means that the procedures and interventions that are performed, can actually prolong their suffering. What attempts should be made to make a patient comfortable? These are all considerations that have to be taken into account. And it is what Dr Darville and I do frequently,” said Ms Budhi.

Ms Budhi said completing an advanced directive, is not just about filling out a piece of paper or a form. Its the process by which you have a conversation, usually with your primary care provider. So that the person you see on a regular basis, the physician and family members, are made aware of what your desires and wishes are.

“Once those desires and wishes are communicated to the physician and the health care facility, we have no option but to follow them. That being said, there are highly technically forms. So if there is any discrepancy, we have to rule in favour of the preservation of life, until we can sort out otherwise,” said Ms Budhi.

Currently, Dr Darville said there are four people in the Doctors Hospital ICU and none of them are able to speak, because they are on breathing machines and they are sedated as well.

“They come in and we don’t know what their desires are, all we know is that their family members have brought them in. And as Michaela said, because there was no decision, or no living will or advance directive, and we use those terms interchangeably, we err on the side of life preservation because nothing was said in advance,” said Dr Darville.

When there are conflicts in health care, Dr Darville said it is mainly because family members come into the hospital and they express different desires of what they know from their family member who is sick. “And the bigger the families, everybody has something called an opinion. An opinion is like a nose, everybody has one,” he said.

“Mom comes with her opinion and the children comes with theirs and opinions vary. They vary based on emotions, relationships, whether temporal or geographic. We have to deal with these opinions in health care and iron out the conflicts. Again, when there is differing in opinions, the living will or advanced directive, can help with that,” said Dr Darville.

Dr Darville said everyone wants the best for their loved ones, but how persons define “the best,” tends to be different. So it is important that when people come to this “end of life” scenario, and determining whether care is futile, the important thing is for them to have good communication and relationships.