In the event of a life-threatening emergency, which of the following do you want to be true?
- I get to determine what measures are taken and what treatment is provided.
- Someone else determines what measures are taken and what treatment is provided based on an external standard, such as a hospital protocol.
- My family members try to choose what measures are taken and what treatment is provided based on their best assumptions of what I might have wanted.
Many people feel strongly that their choice would be #1. They wish to choose for themselves, based on personal values, a course of treatment and a range of options that would be acceptable in the event of terminal illness or life-altering injury. Since the absence of a clear plan can often throw loved ones into divisive and painful decision making, many people choose to outline their wishes in legal documents called an Advance Directive that can give medical personnel and family members a clear expression of our wishes. Especially now, when advanced medical technologies can prolong life artificially, these documents can specify the range of interventions we view as acceptable.
Research shows that only about 18% of American adults prepare advance directives.1 In order to improve those numbers, here is some helpful information to begin the process.
Preparing an Advance Directive
An Advance Directive is a legal document in which you outline your wishes for End-of-Life Care. It can include several parts.
A Durable Power of Attorney for Healthcare allows you to designate someone to act as your spokesperson and decision- maker in the event that you are incapacitated. The person designated should be well acquainted with your values, religious beliefs, medical history, and preferences on issues such as treatment settings, palliative care, organ donation, etc.
A Living Will or Health Care Directive is a document that specifies the types of care you would wish to receive while living with a terminal illness. It allows you to choose or limit the life sustaining treatments you would receive.
A Physician’s Orders for Life-Sustaining Treatment (or POLST) is a portable form in a checklist format that quickly and effectively summarizes your wishes for CPR, medical interventions, antibiotics, and artificially administered nutrition.
Samples of these forms are available on the Washington State Medical association’s website, www.wsma.org/advance-directives. Another source is the Five Wishes form available from Aging with Dignity, www.agingwithdignity.org/forms/5wishes.pdf
In addition to being armed with information and forms, adults need to initiate conversations with their doctors, family members, and religious and legal advisors to openly communicate their wishes and to draft the needed documents. These can then be printed and shared with all who might be asked to express: “What would this person have wanted in this situation?” Thanks to your careful and considerate planning, now they know the answer!
1Working With Seniors: Health, Financial and Social Issues, Society of Certified Senior Advisors, 2009, p. 371.