Standing in front of Donna Carter’s health occupations class earlier this month at Philomath High School, Dr. Dave Cutsforth, Suzanne Cutsforth and Pam Wald act out a scene involving a woman’s husband and daughter discussing what they should do next with their dying loved one.
The daughter believes Mom wouldn’t want to be kept alive in her situation while her father admits that he believes in miracles and just can’t let her go. Without an advanced directive, the situation can evolve into a dilemma not only for family members but for the attending health-care professionals.
You might think it’s a pretty heavy subject for high school students to digest but Carter said her health occupations students — made up of juniors and seniors — have a high maturity level through other serious discussions that have made their way through the classroom.
Dr. Cutsforth, who retired in 2012, believes the presentation can be good information for students who are considering an occupation in health care.
“There’s many things you need to know about and one of them is you may be exposed to some end-of-life health-care situations,” Dr. Cutsforth said about the purpose of the presentation for those students. “So let us educate you about some things that can be done to help prepare you to make that easier for the family and the patient themselves.”
Cutsforth and his wife, Wald and another couple are all part of a local chapter of Compassion & Choices, an organization that focuses on empowering people to chart their end-of-life journey. The outreach effort also involves presentations to other groups from nursing homes to athletic clubs. Coming up, the group will be headed to West Albany, Cutsforth’s high school alma mater.
So, what exactly is an advanced directive?
“An advanced directive is a written or recorded document … that gives some direction about your preference of emergency health care in an eventual end-of-life situation, a health-care situation, in advance of a crisis,” Cutsforth explained.
Advanced directives include two separate documents — a person’s living will and the identification of a person’s designated health-care advocate who has medical durable power of attorney.
The health occupations class features a unit on the life cycle and Carter said part of that is talking about death and dying, and grieving.
“Part of what helps people get to a place of acceptance is to tell and be told the truth, to be surrounded by loved ones, to have their affairs in order and to have lived a life of meaning and purpose,” Carter said. “So working on advanced directives kind of touches on all of those.”
Suzanne Cutsforth, a retired Philomath educator, came up with the idea for the role-playing scenarios to help get the message through to students. The group tries to have fun with the presentations and inserts a degree of humor into the scenarios, even inviting students up to serve as patients.
“This whole idea of talking about death and dying and grieving and preparing for it and looking at advanced directives, some people might be worried is that too much for high school kids?” Carter said. “But I feel like, especially for kids going into the medical field, oh, that’s part of them helping develop empathy for what some of their patients are going to go through.”
It’s the second straight year that the group has talked to Carter’s class.
“Over time as we move forward, they’re very open to feedback and they want to refine and revise and improve,” Carter said. “So I think we can continue to work with them to try to make the presentation even more user-friendly for high school students. But I’m just really appreciative that they care and they’re willing to volunteer their time and come in and talk to the students and answer questions.”
The advanced directives discussion had a twofold purpose.
“We thought, wouldn’t it be nice if health profession students learned about that kind of thing — both personally if they do further their career, but also maybe that they could take that back and let their parents or grandparents know about it,” Dr. Cutsforth said.
Even if a family doesn’t actually have legal documents drawn up on the matter, at least the discussion has taken place.
“I think one of the goals is just maybe to start that conversation whatever way you do,” Suzanne Cutsforth said. “It doesn’t have to be tied particularly to finishing events or completing it, but you could talk about it a little because it really does help in the long run. ... It makes you sit down and makes you think how it can help those around you.”
The Cutsforths and Wald can share all kinds of stories about specific situations, such as the mother who couldn’t make an end-of-life decision about her son who had been seriously injured in a car accident. He was over age 18 and had no advanced directive, so instead of an individual decision for his parent, it became a team decision among her along with the health-care professionals.
All three of them have also experienced personal loss. The Cutsforths were caregivers to their own parents in hospice care and three of the four were cancer patients. One of the components of that involves making sure they’ve made clear what they want as death draws closer.
In the case of Wald, she went through the task in 2012 of helping her husband, who had stage 4 lung cancer, utilize the Death with Dignity Act, which allows terminally ill individuals end their lives through voluntary self-administration of a lethal dose of medication.
At that point in time, Death with Dignity had been in place for 16 years but Wald found the process of navigating through the requirements and finding the support she needed to be a huge challenge.
Wald contacted Compassion & Choices to help with the process — forms and finding a doctor who would prescribe the medication in conjunction with a consulting doctor. David Grube, a Philomath physician who co-founded Philomath Family Medicine with Cutsforth, ended up being the prescribing doctor.
“The reason I’m sitting here is because I got the choice for my husband,” Wald said when asked why she’s involved with the group. “When you love somebody and that’s really your last gift to them and then you don’t get it, these people didn’t get it. So I got involved with that piece and worked with Dr. Grube on some things and then we all came together with this team. We started thinking about advanced directives before you get into that crisis situation.”
Beyond advanced directives, there are various other documents that individuals can consider. You can attach riders to the standard form to clarify a person’s wishes for specific situations.
There is also a completely separate form called Physician Orders for Life-Sustaining Treatment, or POLST, that provides details for personnel such as emergency responders. For example, emergency medical technicians on a call to a person’s home under the law must try to resuscitate, unless they are presented with a POLST form prepared and signed by a medical professional.
Cutsforth shared what he believes is an important message for everyone to consider:
“Be sure and think about what gives you pleasure in life and what you would like to have meaning in life and have conversations with your loved ones about what kind of support you can be for them and what kind of support they could be for you when an end-of-life scenario happens.”