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Medical Care

Bobbi Kristina and Her Family's Ultimate Decision

By Monica Williams-Murphy, MD

Just three short years after the world mourned the shocking death of Whitney Houston, her daughter’s life hangs in the balance. Bobbi Kristina, 21, the daughter of Houston and singer Bobbi Brown, has been in a coma since Jan. 31, when she was found face down in a bathtub in her Georgia home. Now, she is surrounded by family who will likely have to determine her fate. The difficult choice of whether or not to continue artificial life support measures is not a quandary unique to the Houston-Brown family. Many have and may yet face similar difficult medical decisions for someone they love. How do you approach such a decision and keep your sanity, while honoring the wishes of the one you love?

I recommend three strategies to help you and the loved one for whom you are making a medical decision:

Ask for honesty and compassion from the healthcare team

Many doctors are not trained to have honest conversations about a patient’s poor prognosis i.e. that the patient has a high likelihood of dying or entering a vegetative state. So, instead of having a straightforward talk, the doctors may purposely or inadvertently offer false hopes. The most important first step in making a difficult decision for a loved one is to ask for the unvarnished truth, delivered in a compassionate manner, regarding expected outcomes and options. Stand up for yourself and the one that you love.

Forget yourself and focus on the known desires of the patient

Ideally, the patient would have prepared a living will or advanced directive in anticipation of such an event to which you could refer for guidance. However, the vast majority of Americans do not prepare ahead in this manner and certainly younger people like Bobbi Kristina rarely do so. However, a living will should be created by everyone who is of adult age, so that one can make one’s wishes known in advance of potential life threatening events, expected or not. This offers significant support and relief to those who are stuck in a very difficult position of making a medical decision for another.

In the absence of guidance provided by an advance directive, we must turn to the life of our loved one and mine their life’s story for elements that will allow us to make the best decisions on their behalf. Remember, difficult medical decisions should not be made from the perspective of “What do I want for the patient?” but instead should be made from the perspective of “What would she want for herself if she could see herself in this situation?”

Here is a visualization tool to help you develop the correct frame of mind for this challenge:

First, imagine that you are not going to make this medical decision alone, but that the patient (your loved one) is going to help you:

A) Imagine your loved one when they were still awake and able to make a decision for themselves.

B) Think about who he or she was: What are his or her favorite things? What is his or her favorite color? What are his or her hobbies? What is his or her favorite meal? What things did he or she dislike? What were his or her values?

C) Now, imagine that (your loved one) is standing here beside you, looking at himself or herself here in this hospital bed. He or she hears the diagnosis and the available options the doctor has given. What does he or she want us to do, or not do next?

Ask for help from the palliative care team

Mercifully, most hospitals have a palliative care team available. These medical professionals are entirely devoted to helping and supporting the patient and family who are facing decisions of this magnitude. Don’t hesitate to ask your primary medical team for a palliative care consultation. They often offer an all-important “second opinion” as well.

Bobbi Kristina’s family, still recovering from her mother’s death, has to make the most painful decision a family can ever face. So do innumerable Americans who are struggling to make the best medical decisions for someone they love. My hope is that this advice may make an unthinkable situation a little easier.

(The visualization tool described here is available for free download at http://www.oktodie.com/pdf/Fierros4.final.pdf.)

Dr. Monica Williams-Murphy, medical expert for ThirdAge.com, is a board certified Emergency Physician and the Medical Director for Advanced Care Planning and End of Life Education at Huntsville Hospital. She is also the author of It’s Ok to Die, a planning guide to prepare for peace at the end of life.

Photo credit: Helga Esteb, www.shutterstock.com.