Ten Important Questions About Advance Health Care Directives
April 16 is National Healthcare Decisions Day, a time to encourage patients to express their wishes regarding health care, and to encourage families and doctors to know and respect those wishes.
Have you created health care directives? If you haven’t, or you aren’t sure your documents are up to date, here some questions you might have.
Why should people express their wishes about health care? Isn’t that for their doctor to decide?
Today’s health care technologies are pretty amazing. They can keep us alive even if we are suffering from a serious illness. People have different ideas about the treatments they would want to have. If they are able to state their wishes, they can say yes or no to questions like these:
- Would you want CPR or other resuscitation if your heart were to stop beating?
- Would you want to be put on a ventilator if you could no longer breathe on your own?
- Would you wish to have tube or needle feeding if you lost the ability to swallow?
- If you had a life-limiting illness, would you wish to receive antibiotics that might prolong life?
- If you had progressive dementia, what health treatments would you want?
- Would you want to be an organ donor?
- At what point would you want palliative care (care that focuses on pain control and quality of life) rather than aggressive treatment?
We like to think that we will always be capable of making these kinds of health care decisions. Sometimes, however, it doesn’t work like that. A stroke, an automobile accident, Alzheimer’s disease—any number of circumstances might limit or take away our immediate ability to make these decisions. The Gerontological Society of America reports that nearly one in four older Americans today receives “excessive or unwanted medical treatment” because they had not earlier made their wishes known.
Creating advance directives makes it more likely that our wishes would be met, even if we could not speak for ourselves.
What are advance directives?
These are documents that include statements about:
- What you would want. A health care directive or living will is a document that says what kinds of care—including the life-sustaining measures mentioned above—you would or would not want if you were nearing the end of your life. In some states, you can also create a document that would make it less likely that first responders would perform CPR or other procedures on you if you don’t want it. This is called a Physician Orders for Life-Sustaining Treatment (POLST) or something similar (to find information for your state, visit https://polst.org/programs-in-your-state).
- Who you would want to speak for you. A durable power of attorney for health care, medical power of attorney or health care proxy is a document saying who you would like to make health care decisions for you, if a time were to come when you couldn’t speak for yourself.
Who should I choose to serve as my health care proxy/durable power of attorney for health care?
This person would most likely be a relative or close friend. Think about the person you would most trust to make those decisions for you if you weren’t able to do so. That is the person you should appoint as your health care representative. If for some reason the person who would be your first choice were not available to act for you, who would be your second choice? Most forms designating a health care representative allow you to name an alternate.
What should I tell my health care representative?
If you wish to name an individual as your health care representative, ask the person if he or she is willing to take on that responsibility. If the person agrees, then you should sit down with him or her and have a frank, detailed conversation about your feelings and values concerning health care and the kinds of treatment you would or would not want. Along with this conversation, be sure to give your health care representative copies of your health care directive.
Why are these conversations so important?
Yale University researchers recently conducted a study of 349 older patients and their health surrogates. They asked the seniors about what treatment they would prefer if they had a serious illness. Then they asked the health surrogates what they thought the patient would prefer. They found that while the surrogates rated themselves as “extremely confident” that they knew their loved one’s wishes, in fact only 21 percent of their answers matched up with the patient’s!
Even though you’ve stated your wishes in writing, talking about your thoughts with your health care representative and other family members is important. The better understanding those close to you have about your wishes, the more likely it is that you will spend the end of your life in peace and comfort, and that your family will be spared anguishing decisions and conflict during a time that they would rather be focusing on saying goodbye. It is a loving legacy to leave.
Where can I get these forms?
You can ask your doctor for the correct forms to use. Or, visit the National Healthcare Decisions Day website (www.nhdd.org) to find more information about health care planning, and to access free advance directive forms for the state in which you live.
Who should have a copy of my health care directive?
Give a signed and witnessed copy to your primary physician, your health care representative, your hospital, your senior living community, and any other major health care institution or organization with which you are connected. It is also wise to share the information with all family and close friends. Doctors and hospitals report that family members are sometimes surprised by their loved one’s wishes as stated in a living will. Family members may disagree with the patient’s wishes, or among themselves. You can make it easier for everyone by talking openly with your loved ones about what you would want.
What if I don’t know what I want?
Many people hesitate to express their health care wishes because they’re just not sure about what they think! They don’t feel qualified to decide. This is another time when having conversations is a big help. Talk to friends and family. Find out about presentations and discussion groups held at your faith community, senior center, local hospice or senior living community. Consult with a counselor, your spiritual advisor or an aging life care professional (geriatric care manager).
What if I change my mind?
Your right to complete advance directives includes your right to change your mind. In most states, you may cancel an advance directive any time and in any way that clearly shows your intent—for example, by tearing it up, marking it “revoked,” or telling someone you have changed your mind. It’s always a good idea to review your advance directive from time to time to be sure they reflect your current thinking. If you decide to update, let your representative and doctor know.
Can my doctor talk to me about advance care planning?
Yes! As a matter of fact, Medicare now covers advance care planning. Your doctor can counsel you as you make these decisions, and help you fill out the necessary forms. You can ask your doctor about the prognosis if you have health problems. Best to have these conversations well ahead of time. The American Academy of Family Physicians reports stories about “very sick patients who were admitted to the hospital and had end-of-life conversations in the midst of a crisis with unfamiliar doctors.” Said Dr. Nancy Shoenborn, a professor at Johns Hopkins University School of Medicine, “Wouldn’t it be better for patients to have these discussions earlier upstream with their regular doctor who knows them better?”