Although death is an inevitable part of life, many of us in Western society remain reluctant to face the fact that we’re not going to live forever and plan for our end-of-life care. Consequently, many families are left with the stress and heartache of trying to agree on the best way to care for a terminally-ill loved one who is unable to make his wishes known.
Thinking about your end-of-life choices today can improve your quality of life in the future and ease the burden on your family. Discussing your wishes with loved ones and preparing an Advance Health Care Directive offers the best assurance that decisions regarding your future medical care will reflect your own values and desires.
What is an Advance Health Care Directive (AHCD)?
An Advance Health Care Directive (AHCD) is a generic term for a document that instructs others about your medical care should you be unable to make decisions on your own. It only becomes effective under the circumstances delineated in the document, and allows you to do either or both of the following:
- Appoint a health care agent. The AHCD allows you to appoint a health care agent (also known as “Durable Power of Attorney for Health Care,” “Health Care Proxy,” or “attorney-in-fact”), who will have the legal authority to make health care decisions for you if you are no longer able to speak for yourself. This is typically a spouse, but can be another family member, close friend, or anyone else you feel will see that your wishes and expectations are met. The individual named will have authority to make decisions regarding artificial nutrition and hydration and any other measures that prolong life—or not.
- Prepare instructions for health care. The AHCD allows you to make specific written instructions for your future health care in the event of any situation in which you can no longer speak for yourself. Otherwise known as a “Living Will,” it outlines your wishes about life-sustaining medical treatment if you are terminally ill or permanently unconscious, for example.
The Advance Health Care Directive provides a clear statement of wishes about your choice to prolong your life or to withhold or withdraw treatment. You can also choose to request relief from pain even if doing so hastens death. A standard advance directive form provides room to state additional wishes and directions and allows you to leave instructions about organ donations.
|Misconceptions about Advance Health Care Directives|
|You must have an Advance Health Care Directive to stop treatment near the end of life.||Treatment can be stopped without an advance directive if everyone involved agrees. However, without some kind of advance directive, decisions may be more difficult and disputes more likely.|
|An advance directive means “Do not treat.”||An advance directive can express both what you want and don’t want. Even if you do not want treatment to cure you, you should always be kept reasonably pain free and comfortable.|
|If I name a health care proxy, I give up the right to make my own decisions.||Naming a health care proxy or agent does not take away any of your authority. You always have the right, while you are still competent, to override the decision of your proxy or revoke the directive.|
|I should wait until I am sure about what I want before signing an advance directive.||Most of us have some ambivalence about what we would want because treatment near the end of life can be complicated. Advance Health Care Directives can be changed if/when your wishes or circumstances change.|
|Advance directives are only for old people.||Younger adults actually have more at stake, because, if stricken by serious disease or accident, medical technology may keep them alive but insentient for decades. Every person aged 18 or over should prepare a directive.|
|Source: American Bar Association|
Importance of an Advance Health Care Directive
While most people would prefer to die in their own homes, the norm is still for terminally-ill patients to die in the hospital, often receiving ineffective treatments that they may not really want. Their friends and family members can become embroiled in bitter arguments about the best way to care for the patient and consequently miss sharing the final stage of life with their loved one. Also, the opinions and wishes of the dying person are often lost in all the chaos.
It’s almost impossible to know what a dying person’s wishes truly are unless the issues have been discussed ahead of time. Planning ahead with an Advance Health Care Directive can give your principal caregiver, family members, and other loved ones peace of mind when it comes to making decisions about your future health care. It lets everyone know what is important to you, and what is not. Talking about death with those close to us is not about being ghoulish or giving up on life, but a way to ensure greater quality of life, even when faced with a life-limiting illness or tragic accident. When your loved ones are clear about your preferences for treatment, they’re free to devote their energy to care and compassion.
End-of-life issues in an Advance Health Care Directive
Specific issues relate to the end of one’s life. These include:
- Whom do you want to make decisions for you if you are not able to make your own, both on financial matters and health care decisions? The same person may not be right for both.
- What medical treatments and care are acceptable to you? Are there some that you fear?
- Do you wish to be resuscitated if you stop breathing and/or your heart stops?
- Do you want to be hospitalized or stay at home, or somewhere else, if you are seriously or terminally ill?
- How will your care be paid for? Do you have adequate insurance? What might you have overlooked that will be costly at a time when your loved ones are distracted by grieving over your condition or death?
- What actually happens when a person dies? Do you want to know more about what might happen? Will your loved ones be prepared for the decisions they may have to make?
Source: Family Caregiver Alliance
Creating an Advance Health Care Directive
Advance Health Care Directives and living wills are not complicated, but the content can be complex and should be thought through very carefully. It can be short, simple statements about what you want done or not done if you can’t speak for yourself. It’s important to discuss your wishes with family members, legal, health or other appropriate professionals when preparing such a document. It is particularly important to talk with everyone who might be involved about your wishes because in times of stress, others may confuse their own wishes with your wishes.
Most state governments have designed forms for people to complete on their own by filling in the blanks. While these are not usually mandatory, most states do require witnessing or other specific signing formalities. Anything you write by yourself or with a computer software package should follow your state laws. So, it’s essential for you to know what the laws are in your state. While you are not required to seek legal advice to prepare an advance health care directive, it may be a good idea to do so to ensure that the actual instructions for your wishes are stated accurately. It has to be absolutely clear to be enforceable.
Laws differ between states, so consult a lawyer or click here to learn about your state’s laws.
Speak With Your Physician
It is important that you discuss your health care desires with your physician. He or she is likely to be the one caring for you when your instructions become relevant and is much more likely to honor requests that have been communicated directly. Your physician can:
- Help you phrase your requests in a way that makes sense to medical professionals and can answer any questions you may have.
- Point out any illogical or inconsistent features of your requests. Sometimes refusing one kind of treatment makes it illogical to expect to receive another kind of treatment. Your physician can smooth out some of these “rough edges” and help make a consistent and coherent directive.
- Tell you if there are aspects of your requests that he or she cannot honor because of personal, moral, or professional constraints.
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