Feb 2024
Dr. L Shoots
Summary: Most people associate the somewhat crass term of ‘being a vegetable’ with what some describe as a ‘vegetative state’: being artificially kept alive by breathing machines, feeding tubes, and medications, and being unable to walk, talk, or communicate in any meaningful way. It’s pretty universal that no one would like to live like this. So the much bigger questions come when your body is in a state that is not ‘vegetative’ but is nowhere near your normal level of functioning. What would you want then? That’s where Croak can help. When families have to make these health-related decisions, it is often the biggest source of conflict within families. Talking about it beforehand can help everyone to be on the same page and to make informed decisions with confidence.
Communication with family members around their dying wishes is not an easy topic—we get that! One very common thing I hear as an emergency physician over and over again is that individuals think they have told their wishes to their loved ones when really all they’ve told them is ‘they would never want to be a vegetable’.
Except it’s not nearly that simple.
What actually defines being ‘a vegetable’? It sounds crass, but it is actually a really serious and important question.
It’s probably pretty universal that the majority of people would not want to be artificially kept alive if they were in what many non-medical people describe as a ‘vegetative’ state—meaning they had no meaningful way to communicate, no way of moving any parts of their body, and were completely reliant on artificial sources to keep them alive (like breathing machines and tubes directly into the stomach for feeding etc.). This is why I hope we can all agree that telling your loved ones ‘you would never want to be a vegetable’ really isn’t that helpful. The vast majority of people feel this way!
This is why you need to think deeper, and have much deeper discussions with whoever your power of attorney for personal health is, and provide them with much more detail 'advanced directives' to help guide their decision making when the time comes.
For example, what about the individual who has had a massive stroke, and they can move their hand on one side of their body, and wiggle their toes on one side, but they still can’t talk or walk or eat after months of trying to regain function? What if they can open their eyes and look at you, but not communicate with you? What would they want then, if this was their permanent new state? Would they want to be kept alive, and new illnesses like pneumonia aggressively treated? Or would they want you to give doctors permission to keep them comfortable, and not treat new illnesses and let them pass away peacefully?
What about a second scenario—you’re diagnosed with a terminal illness, but you’re still living your life to the fullest you can, still able to travel at this stage and enjoy time with loved ones—but then you suddenly go unconscious. Would you want aggressive therapy to try and bring you back to life, including putting you on a ventilator to breathe for you and putting you in a ‘medically induced coma’ so you can tolerate all of the treatments and tubes required to keep you alive? What if doctors said there was an extremely high risk that after initiating the treatment, we can’t actually bring you back to your previous quality of life and you may never be able to communicate normally again? Would your loved one want doctors to still try anyway?
I could go on and on with examples. The decision to ‘not be a vegetable’ is easy. The much more difficult decisions lie in balancing someone's personal wishes and values—quality of life vs quantity of life. And those answers will be different for everyone.
But the above examples are the kinds of high-stakes scenarios hospitals deal with every single day. And every single day patients’ power of attorney for personal care is asked to help guide physicians with what the patient would want in these types of scenarios. Many times, a legally defined POA does not exist and the default POA becomes the spouse. But it’s also not infrequent that we see a spouse who does not want to take on the role, or, who has children who are very vocal and trying to push certain decisions. So now there are multiple people, with multiple opinions, and the stress levels and conflict within families just rise substantially. It is also very common to see scenarios where the patient has not thoroughly expressed their wishes, and so the POA's decisions are questioned, and conflict between loved ones again occurs.
In healthcare, we are very aware (from both longstanding evidence and lived experience) that this can be some of the biggest sources of conflict when families cannot agree on health-related decisions.
This is why it is so important to talk about your health wishes in advance, well before your body is ever critically ill needing the hospital. Your loved ones need the ability to make informed decisions about what it is you would want, instead of guessing or having their decisions questioned by other loved ones.
This is why we’ve created Croak. It’s meant to be a communication tool that allows you to easily share your wishes with all of your loved ones so everyone knows exactly what you want, and everyone is on the same page. Because it’s a digital platform, you can also do it from the comfort of your own home, and simply email your wishes to your loved ones and spare the awkward conversations. You can also use it as a conversation starter—whatever works best for you and your loved ones. All we care about is that you share your wishes with everyone, so that when the time comes, we all know what it is that YOU want!
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