Don't Make Your Family Guess

Advance directives aren't about refusing care. They're about receiving the care you actually want.

Last year, my mother-in-law suffered a catastrophic brain bleed. Just days earlier, we’d been celebrating her birthday together. In hospital we were told she could survive indefinitely on a ventilator but would never regain meaningful brain function.

Fortunately, she had already made her wishes known.

As heartbreaking as it was, our responsibility wasn’t to make the decision. It was to honour the decision she had already made.

It spared us from having to guess what she would have wanted. I wish every family had that clarity.

Emergency rooms are the worst place to make decisions about life and death.

Unfortunately, they’re where those conversations happen far too often.

I understand why people avoid them. Advance directives. Powers of attorney. Do Not Resuscitate orders. No one enjoys talking about death. But waiting until you’re in crisis—or worse, unconscious—means your wishes may never be heard.

When a young trauma patient arrives, the decision is easy: full code. We do everything.

For elderly patients or those living with advanced chronic illness, it shouldn’t come to that. Conversations about how you want to die should happen long before you’re staring death in the face.

As an emergency physician, my responsibility is to respect a patient's wishes while minimizing suffering. If someone has clearly decided they do not want CPR or mechanical ventilation, performing those interventions isn't heroic. It’s medical assault.

Yet it happens more often than people realize. A family panics. A long-term care home calls 911 because they aren't equipped to manage the dying process. Suddenly, someone who wanted a peaceful death is lying beneath the bright lights of a trauma bay while strangers break their ribs trying to save a life they never wanted prolonged.

Those are some of the hardest cases we see.

Sometimes our job isn't to prevent death. It's to recognize when death is the natural next step and ensure it is as peaceful and dignified as possible. Death is not a medical failure. It's part of life.

The most difficult situations are when families ask us to “do everything,” despite there being no realistic chance of meaningful recovery. I’ve watched people endure days or weeks of invasive treatments because no one was ready to let them go. Their hearts continued to beat, but the person their family loved was already gone.

Love isn’t always measured by how long we can keep someone alive.

Sometimes love means letting them die the way they wanted.

In the emergency department, we're resuscitationists when lives can be saved, palliative physicians when comfort is what's needed, and advocates for our patients always.

But please don’t leave these decisions for the emergency room. Have the conversation. Write down your wishes. Choose someone you trust to speak for you if you no longer can.

Because one of the greatest kindnesses you can leave your loved ones is clarity about your wishes.

When your time comes, they won’t have to wonder whether they made the right decision.

Don’t leave your final wishes to an emergency physician you’ve never met.