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Why a Crystal Clear Healthcare Directive is Essential

There are few conversations more difficult to begin than discussing advance directives. These directives reflect a loved one’s desires for medical treatment when they are unable to decide for themselves.

No one can force anyone to have an advance directive completed. There are no state laws that requires anyone to have one. It is a completely optional document.

However, when a directive is not available and a physician feels the patient is unable or cannot make decision, the decision must be made by the patient’s immediate family, friends, guardian or caregiver. In some cases, legal surrogates, trustees or other physicians are appointed to make an authoritative decision.

Were you in a coma, would you want a spouse, partner or a child to make a decision about your condition? Having to make a life or death decision can have an emotional and psychological effect which can take years to resolve. Also, the decision may not agree with your own preferences or beliefs. An advance directive prevents doubts, guilt and unintended consequences for yourself and others.

Who Should Have One

In July 2017, the Health Affairs Journal cited a study which revealed that only one-third of the American population has a living will. The low percentage may be due to a common belief that only the elderly should have one. That’s an unwise perception.

There are situations where an existing advance directive would be critical to have. Some examples are:

  • A patient in a persistent vegetative condition or comatose state.
  • A loved one with dementia, Alzheimer’s or brain damage that impairs their cognitive abilities.
  • A member of the military that may suffer from a debilitating state and unable to articulate their wishes.
  • Someone that must rely on a ventilator and has difficulty expressing their thoughts.
  • A patient experiencing physical failure such as kidney, cardiac or liver failure.
  • A loved one with a chronic or terminal medical condition that makes verbal expression difficult.

What Decisions Are Included

A living will and a power of attorney for healthcare are distinct documents. However, both are considered to be advanced directives. No matter the name they can include provisions for:

  • The level of care acceptable to assure comfort and relief from pain.
  • The type of nutrition and hydration that will be provided to the loved one.
  • The limits of life-sustaining treatment as desired by the loved one.
  • The loved one’s preferences for organ donation and/or scientific research.
  • Permission or refusal for an autopsy.
  • Permission or refusal of dialysis.
  • Any other requests or information the loved one wants to communicate to their chosen healthcare proxy.

People falsely assume that having an advance directive is an automatic declaration that they do not want or expect life-saving treatment. We need only look at the name to debunk that “I’m going to die” perception. A living will is a key instrument for the living person to ensure that their wishes are clearly understood and carried out. It certainly doesn’t imply that death is the only situation when the document is enforced.

Completing an Advance Directive

You may engage an eldercare lawyer to draft a living will and/or a healthcare power of attorney on your behalf. You can also use free or low cost online resources to do it yourself.

Forms and services are available at:

  • AARP – State by state links to download directive forms.
  • MedicAlert – Offers electronic storage and medical access to care documents matched to your unique ID.
  • MyDirectives – An online service to create and share care plans including a living will.
  • Five Wishes.org – Offers a low-cost do-it-yourself directive online or on paper for children and adults.
  • State Agencies – Forms and requirements vary from state to state. Consult your state’s Department on Aging, Social Services or Secretary of State sites.

Selecting a Healthcare Proxy 

man signing document

Photo by Helloquence

Since you may be incapacitated, an advanced directive requires you to select and name a healthcare agent or proxy. This is a person who will act as a surrogate when a medical decision is required. He or she must make decisions based on your preferences, values and beliefs not their own.

The criteria for choosing are:

  • Your proxy must be at least 18 years old.
  • You may choose to have one primary proxy and an alternate proxy should the first proxy be unavailable.
  • Your proxy does not have to be related to you. You may choose a close family member, relative, a trusted friend or anyone you feel can fulfill the responsibility.
  • Your proxy must have discussed your specific wishes regarding critical medical treatment with you prior to agreeing to be a proxy.
  • Your proxy must consent to being your healthcare agent.
  • Your proxy need not live in close proximity to you. However, your directive must include contact information.

A living will does not specify a healthcare agent but a healthcare power of attorney does. The advantage of having a proxy is that it ensures that family and medical personnel will know who represents your wishes best. There is far less uncertainty when a proxy is there to make the decisions you would make for yourself.

Conclusion

You may choose to keep your advance directive private between yourself and your proxy. Or you can tell your family and friends where to find your directive should it ever be needed. You may also choose to discuss healthcare treatment issues with your personal physician confidentially. How you choose to manage your advance directive is ultimately up to you.

Once you have a living will or healthcare proxy completed, consider filing copies with your physician, hospital and lawyer. You may wish to provide copies to select members of your family for safekeeping.

Having a directive eases minds when critical decisions must be discussed and made. The sooner decisions are made can have a meaningful impact on your treatment and speed your recovery. Advance directives can reduce potential conflicts between family members. It can minimize the guilt and stress that a spouse, partner or child may feel. You will have peace of mind knowing that your wishes are known at all times.

Maria is a Hubspot-certified digital marketer and blogger. This self-confessed rat race refugee left a 20+ year technology career to take on the challenges of family caregiving. She published her first Kindle novel Conway 6-7. Lately, she has been dabbling in interactive fiction game development. She is a Certified Caregiving Advocate and lives near Chicago.

4 Comments

  1. Todd Matthews

    Reply

    I can definitely see the difficulty and sensitivity when discussing advance directives, but I think there’s a place for them. Personally, I’d rather have a healthcare proxy relaying what I want done if I’m in the predicament of being unable to decide for myself rather than have them make an impromptu decision where they have to end up guessing what I want if I can’t decide. I’d say on the safe side, take the time to get one made and make the decision easier on family. 

  2. FredEim88

    Reply

    It’s a very important topic that every family should discuss between each other. You never know if the worst imaginable thing are about to happened to your loved ones. Living will or healthcare proxy should be in place. Especially if the only choice is to turn of the respirator. No one should ever feel guilty about it. Or asked them self if it’s the right choice.

  3. Twack Romero

    Reply

    Well Maria, you have certainly given me pause for thought. I’m not sure that this is an ‘Immotive’ subject but it is certainly one that can have endless discussions and debates. The laws and situations may well be differnt here in the UK  but your article has pushed my buttons enough for me to make further investigations.

    Decisions to be made that are left to family members and, or indeed, loved ones can be devastatingly hard. The long term emotional ramifications just don’t bare thinking about. Not only that, for some, the ‘right’ decision might not be just that because of personal feelings. So hard for all concerned. Over here we do have DNR, or ‘Do not resuscitate,’ which in itself has a history of complications when trying to be enforced.

    The idea of a ‘proxy’ in whichever form seems fit, is a more suited alternative, in my opinion. It can take away any of the emotional stresses that may play a part in the decision making. In truth, it makes a lot of sense for both the family, loved ones and the person who has drawn it up. Food for thought indeed.

    • Maria

      Reply

      It’s a subject that can make people uncomfortable but it’s actually a good thing. A DNR without prior discussion or consideration can devastate a family. Bad feelings and recriminations can last years. I was a proxy for my brother who died very suddenly. He had children in their late teens at the time. He did not want the burden of the decision on them so he asked me to make the decision. They were able to grieve without having the psychological baggage of making medical decisions for their father. Having a proxy can be a relief to your family and peace of mind for yourself. 

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