Advance Directives

April 16, 2015

Thursday, April 16 is National Healthcare Decisions Day (NHDD)

Have you shared your health care preferences with family, friends and health care providers?

Read our article below on The Basics of Advance Directives These legal documents spell out your end-of-life medical preferences when you can’t speak for yourself.

The Basics of Advance Directives

Every person has a right to make decisions about his or her medical care. But in a time of crisis, you may not be able to speak for yourself. A sudden illness, accident or serious injury can strike at anytime. It could render you unconscious or even near death for an extended period of time.

Sadly, life-sustaining treatment can be needed by anyone at any age. It is important to plan ahead for tough decisions that might come up. It may be uncomfortable to consider these issues. But it’s best to deal with them when you’re clear-headed and in good health.

Documenting your wishes for end-of-life or critical care is called having an advance directive. Advance directives include two elements: a living will and a durable power of attorney for health care. Other documents may include specific orders for DNR (do not resuscitate) and organ or tissue donation.

Living will
A living will speaks for you. It spells out your preferences for your health care in case you are incapacitated. You might be terminally ill, permanently unconscious or in the final stages of an illness from which you will not recover. It is a legal document often prepared with a family member or loved one.
It’s important to let family members know that you have a living will. If the time ever comes, your wishes will be documented when hard decisions have to be made. Without this documentation, your family could have to go to court to deal with your medical situation.

A living will calls many emotions and factors into play. Your personal beliefs and values, your religion, your family status, even your finances may impact your decisions. And your opinions about your care may change over time. Be sure to update your living will on a regular basis and let others know the changes you have made.
Most of us don’t have a living will. In fact, 70 percent of Americans do not have one. That means that in a dire situation, someone else will be directing your care. You may get extended life support or other care that you wouldn’t have chosen for yourself.

Durable power of attorney for health care
Another legal document gives a person you designate the power to carry out your medical wishes. This is called a health care durable power of attorney. The person you choose is known as your proxy or your agent.

Your agent may not be a family member. Close relatives can get clouded by grief and might make decisions you would not have made for yourself. Having an agent and/or a living will can ease tensions among family members at a time of crisis.
You may be perfectly healthy when you first draw up an advance directive. It’s hard to imagine all the scenarios that would require an agent to speak for you. Your wishes on certain procedures might be different depending on how sick or injured you are and what the outcomes could be. Because of this, it may be important for you to distinguish between care for a temporary, acute condition from which you can recover versus a condition that is terminal or from which you most likely will not recover.

Keeping a temporary condition versus a more permanent disabling condition in mind, here are just a few things to consider:

1. If you can’t breathe on your own, would you want a machine (a respirator) to pump air into and out of your lungs for you?
2. How long would you want to be left on a respirator if your chances of recovery are poor?
3. If you were to find yourself in a coma, are you prepared for someone to care for you 24 hours a day?
4. Would you want treatment to extend life no matter what condition you might be in? Are there different levels of treatment you would want? Treatment options may include being fed food and water through a tube into your stomach, surgical options and/or treatment with antibiotics or other types of medications.
5. If your heart were to stop, would you want to be resuscitated? If so, under what conditions?
6. If there were a choice, would you want to spend your final days in a hospital, in a special care center or at home?

The American Medical Association suggests you consider consulting with an attorney and your personal doctor in filling out advance directives.

Andrew Redmann, a fourth-year student at the University of Wisconsin School of Medicine and Public Health, was the lead author of a study that interviewed more than 900 surgeons. It asked if they routinely discuss advance directives with their patients before they perform high-risk operations. Only about half the surgeons said they do.

“I’d like to see everyone have a conversation with their loved ones about their preferences in a situation where they are not able to make a health care decision,” Redmann says. “I have an advance directive, and I am 25.”

“Filling out the advance directive provided an opportunity to talk with my family about what I would want if the unthinkable happened,” he says.

“I believe it is a great gift to let your family know what you want, and thus assist them in the excruciating decision-making that often occurs when hard choices need to be made.”

You can get examples of advance directives — living wills and health care powers of attorney forms — for every U.S. state online. Visit the National Hospice and Palliative Care Organization at caringinfo.org. You may reside in more than one state during the year. For example, do you spend the winter months in a warmer climate area? If so, be certain to complete these documents on both states’ forms.

To help facilitate your decisions you can find additional resources at optum.com/nhdd

By Ginny Greene, Editor

This communication is for informational purposes only, and does not constitute legal advice. Please contact a qualified legal professional for advice on advance directives, living wills and all related issues.

Sources:

1. National Institute on Aging. Health and aging: Advance care planning. Accessed: 12/05/2012
2. Redmann AJ, Brasel KJ, Alexander CG, Schwarze ML. Use of advance directives for high-risk operations. Annals of Surgery. 2012;3:418-423. Accessed: 11/12/2012
3. National Hospice and Palliative Care Organization. What to do if family members disagree. Accessed: 12/05/2012
4. National Hospice and Palliative Care Organization. Are you traveling without a map? A layperson’s guide to advance care planning. Accessed: 12/05/2012