Advance Directives: End of Life Discussions for the Living

Life is for living, making plans and enjoying the moments, right?

Who wants to think about — or much less talk about — death? No one wants to, but we all should. As the geriatric population increases, more and more people are faced with life-altering decisions. For example, would you like to be placed on a ventilator if you are unable to breathe on your own? Would you want to be indefinitely maintained by artificial nutrition in order to keep you alive? If so, in what circumstances, and for how long?

It’s also important to remember that these decisions, though more frequent in the aging population, are not just for the elderly. Younger people face unexpected life and death decisions too. Car accidents, aneurisms and work-related injuries are just a few examples that can place an otherwise healthy person on the receiving end of some very difficult questions.

How do you communicate these decisions if you are in an ER surrounded by 20 people yelling for tests, medications, stat X-rays and the like? What if you are unconscious or unable to speak? What if your loved one is, and you are asked to make a decision for her? While none of these scenarios are pleasant, making decisions under these stressful and emotional conditions can be easier if there is an advanced directives document in place.

So what exactly are advance directives?

An advance directive is a legal document that allows you to spell out your decisions about end-of-life care ahead of time. It gives you a way to express your end-of-life wishes to family, friends and health care professionals, allowing your medical decisions to be honored in the event that you are unable to voice your wishes to healthcare providers at the time the decisions need to be made.

Advance directive templates can be obtained from hospitals, doctors’ offices, libraries and even on the internet. You may also choose to have the advance directives drawn up by an attorney and/or notarized.

An advance directive is about more than just filling out a form, however. In creating or completing this document, it is important to truly contemplate what matters to you. What can and can’t you live without? Quality of life is a major factor when deciding what measures to take and not take. Religious, cultural and ethical beliefs will also affect end-of-life decisions.

Questions considered include what a person would want in a life threatening emergency. Such emergencies could include cardiac arrest, stroke, catastrophic injury and organ failure. Your wishes surrounding the administration of life-saving measures such as CPR (cardiopulmonary resuscitation), artificial feeding, blood transfusions and artificial ventilation are answered in this document. In order to be able to answer these difficult questions, you must also consider that being kept alive may not mean having the same quality of life. For example: Do you want to remain on a ventilator if you have severe brain damage with little hope of recovery?

As part of the process, advance directives also require a person to designate a power of attorney for health care to carry out the patient’s wishes. A power of attorney goes into effect once a person is deemed unable to make his own decisions. The person chosen should be someone who is trustworthy, in good health and able to actually follow the stated wishes.

Before designation of a power of attorney, it is imperative to have a conversation with this person about their ability and willingness to act in this role. Will your adult son or daughter really be able to “pull the plug,” so to speak? People you may consider might have reservations, moral objections, religious beliefs and/or ethical concerns related to following your advance directives. It’s important to be sure that the person you choose is comfortable with all that is entailed with honoring your wishes.

Once the advance directive is complete, it is of the utmost importance that the necessary people are aware of it. The original copy should be stored in a secure place in the home (such as a safe). Copies should be given to the power of attorney for health care, all involved doctors, your attorney, hospital (upon admission), adult children and any other pertinent people. Your wishes should also be discussed more thoroughly with your primary care physician.

Advance directives are very serious and need to be given proper time and consideration before completion. Discussing end of life issues is no easy task. However, not having one’s wishes known could result in dire consequences.

These topics can be easier to discuss with someone who can be more objective and is not personally involved. Many people choose to speak with their religious advisor, spouse, adult children and/or a clinical therapist before finalizing such important decisions. Also, keep in mind that once complete, the advance directives can be changed should your views or wishes change over time.

So, go on — enjoy life’s moments, but also take the time and effort to put together an advance directives to give yourself a sense of peace knowing that your final wishes will be honored.

If you need to discuss these issues more, feel free to contact one of your counselors at Thriveworks Counseling, Beverly Hills.

Any thoughts or questions on creating advance directives? Let’s talk about it in the comments section below.

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