ADVANCE MEDICAL DIRECTIVES & END OF LIFE DECISIONS
Advance care planning is not just about old age. At any age, a medical crisis could leave you too ill to make your own healthcare decisions. Even if you are not sick now, planning for health care in the future is an important step toward making sure you get the medical care you would want, if you are unable to speak for yourself and doctors and family members are making the decisions for you.
WHAT IS AN ADVANCE MEDICAL DIRECTIVE?
Advance care planning involves learning about the types of decisions that might need to be made, considering those decisions ahead of time, and then letting others know—both your family and your healthcare providers—about your preferences. These preferences are often put into an advance directive, a legal document that goes into effect only if you are incapacitated and unable to speak for yourself. This could be the result of disease or severe injury—no matter how old you are. It helps others know what type of medical care you want.
An advance directive also allows you to express your values and desires related to end-of-life care. You might think of it as a living document—one that you can adjust as your situation changes because of new information or a change in your health.
WHO SHOULD YOU TALK TO?
Imagine the group of people who would likely surround your bed to comfort and care for you if you fell gravely ill— the people who are most concerned about your well-being and who would be involved in making medical decisions for you if you could not do so. They might include family members, close friends, your healthcare provider(s), your clergy or spiritual leader, and perhaps your attorney. Make a list of those people, and make a point of having an individual discussion with each one of them to share your desires and preferences. Now, you may find that some are resistant to such serious talk; they may feel it is unnecessary, or “bad luck,” or perhaps even morbid. These are probably the folks who most need to hear your message. They may need to be convinced that, even though your beliefs and your wishes may conflict with theirs, you sincerely want them to understand and respect the way you’d like to be treated if the time comes when you’re not able to speak for yourself.
WHAT KIND OF DOCUMENTATION DO YOU NEED?
Do you need complicated and expensive legal documents prepared by an attorney? Not necessarily. In fact, sometimes these documents specify such minute detail or hard and fast rules that they’re very difficult to follow in any practical manner. In end of life or critical care situations, the question of “the right thing to do” is rarely black and white. It isn’t realistic to plan on “pulling the plug” after a specified number of hours or days—the nuances of real life situations are much more subtle than that; there can be many interrelated circumstances that cannot be anticipated or planned for.
A “Medical Power of Attorney” is a useful legal document. It designates an “agent” who will make medical decisions on your behalf if you are unable to do so. It makes sense, then, that the person you choose to be your agent understands, respects, and intends to carry out your wishes if it becomes necessary for him/her to do so. You can make this document as specific as you wish, and it applies to any medical condition in which you are incapacitated—not just terminal ones. Another alternative is to simply type or hand-write and sign a document stating a list of your preferences. But remember, any document stuck in a drawer or filing cabinet will not be very useful if your loved ones and medical providers don’t know that it’s there or what it says. Regardless of what kind of documentation you choose to use, make copies for your family members, your physician, and your attorney if you have one. And take copies along if you are admitted to the hospital.