Who Should do an Advance Directive?
- All of us over the age of 18
- It is not about being older, Terry Schiavo was 27!
- With all of the talk about advance care planning only 25-30% of people have an advance directive
- For young healthy adults-
Have one for the purpose making decisions in an accident or trauma (examples could include a car accident, boating accident, snowmobiles, motorcycles, etc.) A sudden accident or injury could leave you unable to make your own decisions. This planning tool can help you for an unexpected event.
- For the chronically ill-
It is important to understand what life supports may be needed at a certain point to treat your illness.
- For the terminally ill-
It is needed to explore comfort and quality at this time of life
Why should I do an Advance Directive?
- 80% of deaths happen in a health care facility
- 50% of people are unable to make their own decisions at the time of death
- When there is no advance health care directive, well-meaning providers will often “treat”
- Your loved ones may not be able to predict what you would want without talking with you
- Of the thousands of people who die each day, two-thirds of those cases will involve elements of a decision that the family will need to make
Health Care Agent-Considerations for Choosing the Best Person
One of the most important factors in formulating an advance directive is choosing your health care agent. An appropriate healthcare agent may not be the person who loves you the most, but someone who understands your beliefs and views. These are some of the important factors to consider when making your selection:
- Is the person really willing to take on this responsibility?
- Are they able to respect and follow your wishes, even if they disagree?
- Is this person someone who can withstand stress and emotionally charged conversations?
- Is this person able to be assertive and withstand disagreement with a physician, if necessary?
- Is this person able to make necessary, difficult decisions?
- Is this person readily accessible--does not need to be geographically close.
Which Document Do I Use?
There are many types of Advance Directive documents- here are a few examples:
Power of Attorney for Health Care-POAHC. All states now recognize some type of POAHC. The State of Wisconsin has its own state document. http://dhs.wisconsin.gov/forms/Advdirectives/F00085.pdf
- Living Will- An older document which ONLY deals with a person in a persistent vegetative state or a terminal condition (misses many other conditions such as Alzheimers Disease.)
- Five Wishes, this document is valid in 40 states agingwithdignity.org
- Durable POAHC-drafted by attorneys. These documents are valid documents that will meet all legal requirements. These are good documents, however you may want to talk to an advance care planning facilitator or someone else, so you truly understand the medical terminology and the choices regarding medical care that are included in this document.
Additional resources for documents:
caringinfo.com has all states’ documents
Advance Care Planning and Advanced Directives
Medical technology has influenced the way health care is delivered. Very important to good advance care planning is choosing an appropriate health care agent (a person who can make health care decisions for you if you become unable to do so) and having a meaningful discussion with them so they are able to know your health condition, your values and your choices regarding future health care.
Advance care planning is a process, and will need to be done over time, and changed as your health or quality of life changes. Once you have expressed your feelings and chosen an agent you will be ready to formulate a plan and make a legal Advance Directive document.
Persistent Vegetative State (PVS)
So often when we discuss advance health care planning people make the general comment that “I don’t want to be kept alive if I am a vegetable.”
While this lets people know a general idea of the condition that people are talking about it does little to actually guide the type of care wanted by that person. Let’s define PVS, or persistent vegetative state. It is a specific clinical diagnosis indicating that higher brain function is gone but that brain stem or lower brain function is still in tact. The intact brain stem allows for the coordination of basic body functions like heart beat and respiration but higher functions such as thinking, feeling or hearing do not work. It might be helpful to consider these questions: are there times when you would rather die than be supported by medical interventions, life supports? Do you want to try any or all interventions that may be available? And how do you want to live at the end of life? Regarding medically assisted nutrition and hydration, the Catholic Church teaches that, while they are not morally obligatory in cases when they become excessively burdensome, in principle, they should be provided to patients who need them, even those in PVS. For detailed information on the US Bishops teaching go to:
Self Determination Act-Why the Hospital Asks for your Advance Directive
Why does the hospital always ask me if I have an advance directive?
Because it is the law.
Advance directives are grounded in "Patient Self Determination Act". This law has to do with a person's right to their own decisions, respect for person and the right of informed consent. This law went into effect in 1991 and requires the following of hospitals:
- Inform all patients of their right to formulate an advance directive.
- Provide written information to patients concerning their health care decision making rights, including the right to accept or refuse treatment.
- Compliance with state laws regarding advance directives
- Education for staff and public about advance directives
- Documentation of advance directives in the medical record.
From an Ethic of "rights" to an Ethic of "care"
Although advance directives are a patient "right" good advance care planning is about good ethics of "care." Planning for advanced age, frailty, or incapacity is something that we all need to be thinking about. The ethic of care centers on boundaries and roles and relationships. As the daughter who enters into being a care-giver and decision-maker asks, "How do I care for my mother at this time in her life, and this time in my life?" "What help and resources do I need?" "What will living well at the end of life mean to my mother and how can I honor the commitments I am making?" "How can I be a good caregiver, family member, and employee all at the same time?" These are the types of important questions that good advance care planning can help you formulate answers to. "Caring" is much more than the decision to start or stop life-support treatment.
Cultural and spiritual issues in advance care planning
There are lots of factors that go into good advance care planning and one is to consider spiritual and cultural issues that effect end of life decision-making. It is of value to seek out a spiritual advisor or clergy to assist in these conversations. What religious beliefs influence the type of decisions that need to be made? What cultural issues are present in who a person trusts with this type of decision making, or how people make decisions, who is included -one person or a whole extended family? What does my faith tradition believe about when life begins or ends? Does my natural heritage value independence or are there other factors we need to consider?
Contact your local Ministry facility for more information and assistance in completing advance directives.