Honoring Choices…Discussions on Health Care Directives and Advanced Care Planning

At dinner the other night, a friend asked if I had a list of all the things an adult child should discuss with their aging parent.  As we delved deeper into the question, it turned out that my friend’s mother on many occasions had alluded to a “file” that contained all her necessary paperwork but had never gone beyond that introduction.  My friend wanted to know how to learn more about what her mom really had in the file and what she should ensure is completed.

After having this discussion, I believe that I will over the next few months talk about some of different documents you should have in this “file” and some of the things to focus on as you discuss this with your aging family members.  For me,  one of the most important documents to ensure is completed is the Health Care Directive.  This document may be more recognizable to some under the name of living will.  But, no matter what it is called it is a document that has written “directions” on the course that someone would like family (or other designated individuals) to take if they are not able to express their wishes on health care and an option to appoint someone to be the “voice” of that person around these decisions.

Many clearly remember the Terri Schiavo case and the public fight that took place between her husband and her parents on the course that medical interventions should take.  Terri who was unable to express her wishes had never formally written down her thoughts on medical care and had not directly named an agent to make these decisions if she was unable.  Her life became public fodder and the family had to fight for what they believed would have been her wishes. It is difficult in those times of medical crisis to truly know if what you believe would be the wishes of the patient are truly their own or are they being inevitably mixed in with one’s own grief and loss.

Having a written document is a true gift for those left to make the decision.  Sometimes just having the conversation itself without the immediate completion of the document can enhance a families understanding of each other’s philosophies and goals in the face of a medical crisis.  I learned a valuable lesson in my own family when I made the assumption that my husband would be able to follow any and all directions that I put in my own document.  In a nonchalant manner one day in the car, I mentioned that if x, y or z happened in the course of an illness, then I would want the a, b and c to take place. I was surprised to learn that my husband was not comfortable with a, b and c and would need the support of another agent to follow through on these wishes.  In addition, it was important for me to define what I meant about my choices and how I believed these could be met.

When talking with family members about health care choices, it is important to use this time to really explore the “easy statements”.  What does it really mean to a person when they say: “I don’t want to suffer”, or “I want to be kept comfortable?”  The document should ask questions beyond whether someone wants CPR (cardio-pulmonary resuscitation). It should include questions such as: “The things that make life most worth living to me are…” and “My beliefs about when life would be no longer worth living…”  It can also include ways that an individual wants their religious beliefs upheld (it may be important to include your Rabbi in this conversation).

It is important that the completion of this document is not overlooked only for fear of hurting a family member’s feelings if they are not listed as the primary agent.  I believe that often health care directives are not completed because the individual does not want to have to choose one family member over another.  While appointing several family members as agents may be useful, one does not want to have an endless list of names; for by doing so will only lead to communication breakdowns and confusion.  Often one family member will stand out as the right choice because they may have a medical background, are good under stress, are good communicators and most importantly are comfortable voicing the individual’s wishes and not confusing them with their own (if a difference does exist).  Some families will divide the duties of the different types of decision making; i.e. legal, financial and health, to give everyone a say in the plan of care.

While every state has slightly different legal requirements for the document to be utilized, most require the document’s signature to be witnessed or notarized. When naming an agent, always have a direct conversation with that person and ensure that they have an up to date copy at their disposal.  Take your completed document to your next doctor appointment and review it with your physician to ensure that it is inclusive of as many of the symptoms and or treatment options that could be available to you if you already have a diagnosed chronic or acute illness.

And, one final thought.  These documents are not just for older adults or those with a diagnosed illness. These are for anyone 18 and older.  Remember accidents do occur and if you are facing a medical crisis after a serious car accident or acute illness, will those around you truly know your wishes around treatment?  It is not too late to give a Hanukkah gift to your family members and start the conversation and complete the document.  May you all have a healthy start to the New Year.

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