Many people find it hard to talk about serious illnesses or life-threatening emergencies. Yet it’s important to make sure your loved ones know what you wish to be done about your medical care before you are faced with a serious accident or illness.
That’s where an advance directive comes in.
Advance directives provide you with the tools you need to help you tell others about your wishes regarding treatments such as resuscitation and life-support machines. These documents allow you to state what your preferences are for medical care.
Types of Advance Directives
The most common types of advance directives are:
Living will. This is a written, legal document that clearly states what types of medical treatments and life-sustaining measures you do and don’t want. These can include being placed on a ventilator (a machine that breathes for you), tube feeding, surgery, etc. You also may hear the living will called a health care declaration or health care directive.
Durable Power of Attorney for Health Care Decisions. This may be called a medical power of attorney. With this legal document you designate someone to make medical decisions for you if you become unable to do so. The person you designate is your health care agent or proxy. This document applies only to medical decisions and does not grant this person the rights to make financial transactions for you.
Making Medical Decisions
You may want to talk with your doctor and your family about your medical wishes. You should consider your personal values including the importance of independence and self-sufficiency. Your religious views also may help you make these decisions. You also should consider whether your prognosis (likelihood of recovery) would make a difference in whether you would want to receive that type of treatment.
Treatments to consider include:
Resuscitation. This is used to restart your heart if it should stop bating. You can decide if and when you would want to be resuscitated by cardiopulmonary resuscitation (CPR) or by a device that uses an electric shock to start the heart. Some people with a terminal illness decided that they do not want any resuscitation.
Mechanical Ventilation. If you can’t breathe on your own, a machine can be used to breathe for you. You should consider if, when and for how long you would want to be on a ventilator.
Nutritional and Hydration Assistance. This is used to give your body nutrients and fluids either intravenously or by using a tube into the stomach. You should consider if, when and for how long you would want to be fed like this.
Hemodialysis. If your kidneys stop working, a dialysis machine can be used to remove waste from the blood and manage your fluid levels. In some cases, dialysis may be temporary but it can be permanent.
Treatments for end-of-life stage. If you have a terminal illness such as cancer, you should decide whether you want treatments such as antibiotics, pain medication, and ventilation. Would you want to receive only comfort or palliative care if you were terminally ill? If the treatment would delay your death, would you still want to receive them?
Organ donation. Donating organs including kidneys, lungs, heart, skin and corneas can help others. If you would like to be an organ donor, you should talk with your family and your doctor about what organs you want to donate.
Choosing a Health Care Agent
You should carefully consider whom you would designate as your health care agent. This person doesn’t have to be a member of your family. You should feel comfortable with the person you choose and be able to discuss end-of-life decisions with him or her. Once you’ve made the decision, you should talk with that person to make sure he or she is willing to act as your agent for health care decisions. Once he or she agrees, you also should let your family and physician know who has been selected. Some people also choose an alternate in case the first person can’t be reached in an emergency.
You can also get the forms for Advance Directives from your local hospital. You will get information about what each of the forms does and how to complete the forms. Once you’ve completed the forms, you should give copies to your doctor, your designated health care decisionmaker(s) and family members.
You can revise or cancel your advance directive at any time regardless of your physical or mental condition. You’ll need to let your doctor, attorney, agent and family members of any changes you make.
Starting the Conversation
Serious illness and death aren’t easy subjects to talk about. But by talking about these issues, you can help ensure that you receive the type of care you want, when you want it.
When talking with your family about advance directives, be matter-of-fact and reassuring. Your goal is to take some of the burden off your family by making your wishes known.