Making medical treatment preferences known
February 18, 2006 8:25 AM   Subscribe

How can I make my medical treatment preferences, not just in case of a living will, known?

Last April I had my wisdom teeth removed. I have Raynaud's syndrome, so sometimes I am a hard stick when it comes to starting an IV (my veins constrict - it's taken up to 6 tries to start an IV in the past). I was nervous, in pain from already having been stuck twice, and under the influence of laughing gas when the oral surgeon decided that the best way to "open up a vein and bring it closer to the surface" would be to submerge my hands in very hot water. Because of the Raynaud's, which comes with a sensitivity to temperature, this was extremely painful. I told the surgeon, and he ran a bit of cold water into the sink and said "we can't make it much colder or it won't work." I was asked to hold both my hands in painfully hot water for 5 minutes, and if I wanted to I could probably argue both diminished capacity and risk of injury, as I had to walk to the sink under the influence of laughing gas.

I would like to create a legal document that, unless it is an emergency, forbids this sort of nonsense and pain, perhaps along with a section that says they get one shot per arm and after that, I get a local anesthetic/topical anesthetic. (And it CAN be done - I've had an injected local anesthetic for starting an IV, even though many times they simply state "we don't numb.") Obviously if it is an emergency, just get the darned IV in any way they have to.

What would I call this document - it's not really a living will as I may not be unconscious, as I noted before. And what would it take to make it legal - would I need it notarized, need a lawyer, etc?
posted by IndigoRain to Health & Fitness (5 answers total)
Best answer: I am neither a lawyer nor a doctor, but it's my understanding that an Advance Directive allows you to lay out binding healthcare instructions for any situation where you're unable to speak for yourself. Not just for end of life, as a living will would.

Talk to your doctors and other healthcare providers at the outset of every appointment. Don't be shy about drilling into their heads what your condition is. Those folks see so many people in a day, we all probably blur together unless someone make an effort to remind them of our unique circumstances. Hopefully at least for routine care you'll be able to ensure that they're sensitive to your Raynaud's.

And never go back to a doctor who treats your pain as dismissively as this one did. What a jerk.
posted by nakedcodemonkey at 8:56 AM on February 18, 2006

Honestly, I can't believe that the surgeon insisted that you do that.

So let me see if I understand -- you're looking for some sort of document that will outline what can and can't be done to you?

In cases where your capacity to make these judgements in real time isn't diminished, there is no document that sufficiently substitutes for your actual words at that moment; at the time that your surgeon told you you needed to submerge your hands in hot water, if it was unacceptable to you, you can simply state at that moment that you do not want to. And if your doctor makes you do so despite that, or coerces you to do so despite that, then it's simple battery, and he or she can easily lose his or her license for it. In your case, you had already had nitrous oxide administered, though -- but you still had discomfort, and still clearly felt that it was wrong of the surgeon to do, so you still need to speak up.

In cases where you are to be put in a situation where you can't make decisions for yourself, you might be able to come up with some sort of document, but there's no way that your document can cover all possible things that a doctor might do to you that you don't want done. Instead, you need to be 100% firm and clear with your doctor before anything is administered to you -- say, forthrightly, that you do not want anything done that you don't overtly consent to after the point where you feel you can no longer make informed, rational decisions. Again, any doctor who tries to dissuade you of this is not a doctor you want.

I guess what I'm trying to say is that there is no piece of paper that substitutes, in instances like you describe, for your overt insistance that your doctor adheres to your wishes.
posted by delfuego at 10:39 AM on February 18, 2006

What nakedcodemonkey said.
posted by frogan at 1:40 PM on February 18, 2006

If you have someone you trust (parent, significant other, close personal friend), discuss these issues with them and then have a lawyer help you prepare a Power of Attorney for Healthcare. This gives your agent the power to make these decisions for you if you are unavailable to do so (i.e. laughing gas, unconscious, etc). Also, let your physicians know about this after you do it, so they are expecting the agent's participation.
posted by MrZero at 5:09 PM on February 18, 2006

Check with the diabetes, epilepsy and allergy support organizations. They supply wallet cards, keychain tags, bracelets and necklaces that alert emergency medical personnel to particular problems.
posted by KRS at 12:24 PM on February 19, 2006

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