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Living Wills and COVID-19

Kaiser Health News is reporting the coronavirus pandemic is prompting many seniors to create or modify their Living Wills. The topic of intubation is the leading concern leading to the crafting or rethinking of Living Will strategies. This is happening amidst a wealth of disparate COVID-19 information that makes forming reliable conclusions for decision-making, dubious at best. This is not just a "seniors" issue. Just this past Friday, I met with a 50 year old single mother who raised these very concerns.

Initial reports were suggesting the use of a ventilator was showing signs of promise in severe cases of COVID-19. This machine pumps oxygen throughout a patient's body while lying in bed, sedated, with a breathing tube down their windpipe. Unfortunately, further into the pandemic timeline, these same machines that help patients to overcome respiratory failure appear to have discouraging effects on the patients' survival rates.

Even more dismal is the prognosis of an older adult with COVID-19 placed on a ventilator with an underlying medical condition like lung, kidney, or heart disease. These older COVID-19 patients who do survive, spend considerably longer (two weeks or more) on a ventilator and tend to come out of the treatment extremely weak, de-conditioned, often suffering delirium, and requiring months of rehabilitative care. Unfortunately, these post-ventilator conditions have not been limited to seniors with compromised medical conditions.

As a result, many seniors are revising their Advance Healthcare Directive to address the case of COVID-19 specifically, and are opting out on the use of a ventilator. For example, Joyce Edwards from St Paul, Minnesota, who is unmarried and living on her own with no children, spoke to the issue stating, "I have to think about what the quality of my life is going to be. Could I live independently and take care of myself and the things I value the most? There's no spouse or adult children to take care of me. Who would step into the breach and look after me while I am in recovery?" And then, there is the costs. "How will it be paid for? Will I lose all my assets paying for rehab? Or, will it be taken as reimbursement after I die?"

Joyce's situation is not uncommon in the United States. American seniors are more likely to live alone than ever before: the new mantra of "aging in place." Living alone, however, does not mean they do not have family, somewhere. Still, in the case of contracting COVID-19 and the difficulties recovery can present, many seniors prefer not to upend the lives of their children to prolong their own lives. Some seniors prefer to 'go quietly into the good night' after a life well-lived. They are conceding, in writing, that COVID-19 should be considered a situation where the exercise of extraordinary measures should not be undertaken to keep them alive. This is not how they wish to spend their final months, weeks, or days. It is especially true in the case of intubation, where a patient is essentially in a comatose state and unable to communicate with loved ones before they might pass on.