This past June, two Phi Gamma Delta fraternity brothers at the University of Missouri were charged in the hazing of 19-year-old Danny Santulli. On Oct. 20, 2021, the then-freshman pledge had been forced to drink a liter of vodka in addition to being funnel-fed a beer. He arrived at the hospital in cardiac arrest, and experienced brain damage so severe that he currently lives wheelchair bound, blind and unable to communicate.
Unfortunately, the Santulli hazing case is far from rare, and mirrors drinking and hazing incidents here at the University of Michigan. Our community, and Ann Arbor at large, is a hub for bar crawls, fraternity parties, block parties, tailgates and other events that are often the perfect recipe for a night in the emergency room. Given these risks, it is concerning that so many young people do not have a plan for what they would want to have happen to them in the event that they are too incapacitated to make their own medical decisions, especially in cases where life-or-death options need to be assessed.
In the U.S., the official document that outlines these predetermined medical wishes is known as an advanced health care directive, or living will. An advanced directive provides a crucial framework for health care professionals to tailor their choices or treatments to patients’ preferences and keeps autonomy in the patient’s hands when they are the most vulnerable. Similarly, it clears up confusion or disagreement about a patient’s preferences between loved ones making decisions on their behalf.
However, college-aged students have a dangerous mindset that terminal illness, coma or injury won’t apply to them for the foreseeable future, and they opt to focus on more immediate issues like longitudinal internships, graduate school or job offers. The long life expectancy of the average American further instills the disregard for the creation of advanced directives at a young age. The COVID-19 pandemic, coupled with the increasingly higher rates of intoxication incidence and mortality in this age group, clearly demonstrates that college students are more vulnerable than they think. By forgoing the steps necessary to establish proper end-of-life procedures, they are at the forefront of propagating a public health crisis that leaves providers and loved ones choiceless.
It is true that undergrads have a million things on their plates, and the last thing we want to concern ourselves with is enumerating the resuscitation efforts we would and would not be comfortable with. But, for some young people, they don’t even know how they should go about consenting to chest compressions, defibrillation, intubation, ventilation, vasopressors and more. What the heck even is a “vasopressor,” and why should I care?
In addition to the seeming disregard of advanced health care directives among adults, at no point in our lives are we ever explained how exactly we should handle this situation. The state of Michigan mandates a health class as a requirement for a high school diploma, but nowhere in that curriculum does it encourage young people to consider if being stuck on a ventilator is something they want their bodies to rely on, or if pharmacological intervention to constrict their blood vessels in attempts to raise a failing blood pressure is worth it.
So, even for the youth proactive enough to make an advanced directive for themselves, their lack of understanding about resuscitation procedures leaves them consenting to interventions they might not truly be comfortable with if any ever became necessary. The only instance where resuscitation procedures are explicitly explained and discussed to a patient is when they are already in a hospital or clinic with their attending physician — long after their initial malady.
Eastern Michigan University student Dominic Consiglio, a 911 dispatcher and EMT for Washtenaw County, has witnessed some of the most gruesome scenes involving college-aged students. In his time at Huron Valley Ambulance Partners, Consiglio explains, “constantly hearing and seeing people my age beg for medical help when they are bleeding out, high off drugs, or smashed between two cars scared me enough to get my own advanced directive. I can’t imagine not having precautions in place to affirm that I do want to be resuscitated, but will want to peacefully pass away if 30 days on a ventilator isn’t working for my body.”
The solution to the decision-making burden of college students, most of whom have no medical knowledge, is known as a Durable Power of Attorney (DPOA). Instead of consenting to a limited number of procedures or time frames, a DPOA form allows you to name a person, known as a healthcare proxy, to make decisions for you if you are unable to do so. However, DPOAs are not equitable for young people who a) do not have people they can trust to respect their decisions or core values, and b) have no one in their circle with an intimate understanding of the dire outcomes of a resuscitation.
Critics of advanced health care directives, DPOAs and other end-of-life paperwork, particularly for youth, often cite a religious or moral code to substantiate their belief that humans do not have the right to deny life-saving treatment. For example, the Catholic Church’s official stance is that any kind of physician-assisted death is both a sin and congruent to suicide. Parents of terminal young adults, too, fight back against end-of-life paperwork that does not allow them to determine their child’s fate.
These concerning stances are strikingly similar to anti-abortion arguments that catalyzed the recent overturning of Roe v. Wade by demonstrating a one-dimensional perspective on life quality. Some pro-life proponents do not believe that the extent to which a baby would live a comfortable life should be a factor in the decision to have an abortion. This belief mirrors their opinion that our inherent personhood is something we do not have the right to give up, even in the case of permanent brain damage, organ failure or hospitalization.
The future can be bright, however. Michigan legislation mandating organ registry questions for the acquisition of driver’s licenses needs to be expanded to push youths to complete a more exhaustive list of yes and no questions about their wishes coming out of a critical car accident. Health insurance companies, too, can do their part to incentivize young adults to plan for a terminal health care crisis through life co-insurance plans, lower ER copays for people with end-of-life paperwork and same-rate health insurance coverage for post-resuscitation care.
Most importantly, the ball is in the physician’s court. These are the most qualified people we trust to make decisions about our bodies, and it is crucial that physicians of all specialties promote early and transparent discussions with younger patients about death. Palliative medicine is an interdisciplinary field, and attention to its care techniques equips people to hash out their personal philosophies about artificial life extension methods and tangible alternatives.
Personal medical decisions are complicated by a plethora of lived experiences, morals and tolerances for diminishing quality of life. There doesn’t exist an ideal advanced directive, and no young person should treat it as a formulaic document. Medical wishes are a malleable reflection of ever-changing perspectives, and to have directive or DPOA paperwork in place safeguards what you feel most comfortable with in this stage of life — nothing more, nothing less. If you are a student and would like to get help creating or notarizing an advanced directive, please visit the University of Michigan Student Legal Services website.
Namratha Nelapudi is an Opinion Columnist and can be reached at firstname.lastname@example.org.