Communicate Your Health Care Wishes in Writing
Part 1 of a 3-Part Series on Advance Health Care Directives
It can happen to anyone. A devastating illness or accident can leave a person incapacitated, unable to make decisions about medical care. If it happened to you, would your family and friends know what sort of medical treatments and procedures you would wish to have?
A document called an “advance health care directive” lets your loved ones know exactly what your wishes are, such as whether you want your life prolonged by any means necessary or you prefer to have some treatments withheld. The advance directive also designates an “agent” – and possibly alternate agents – who should make medical decisions for you and provides instructions for what treatments you would or would not want. There is no requirement to give specific detail on your end-of-life treatment wishes, but you do want to have on record the persons who would be able to speak on your behalf regarding treatment.
“Some people mistakenly believe that an advance directive is just a ‘do not resuscitate’ order that some chronically or critically ill patients may have on file, but that simply is not the case,” says Washington Hospital’s Spiritual Care Coordinator Michelle Hedding, MA, RN, CHPN (certified hospice and palliative care nurse). “The hospital does have a duty to attempt to resuscitate the patient in the absence of directions that specify otherwise. Advance directives are comprehensive documents, though, that let you decide not only what kinds of treatments you would want if you became incapacitated, but also who you would want to make those critical decisions for you.”
At Washington Hospital, all patients are asked if they have an advance directive when they are admitted to the hospital. If patients do not have an advance directive, they are provided with information about creating one.
“The best time to fill out an advance directive is when you are healthy and in a good frame of mind, not at a hospital when you’re already facing a health care crisis,” Hedding notes. “Most of us have a tendency to procrastinate in creating or updating an advance directive when we’re healthy, but these critical situations can turn on a dime. Anyone over age 18 should have an advance directive because life-threatening medical emergencies can happen at any time, and at any age.”
Advance directives can take various forms, with laws varying from state to state. In California, an advance health care directive combines elements of a “living will” with a “health care power of attorney” (HCPOA). A living will allows you to state whether you want your life prolonged if you will die soon from a terminal illness or are permanently unconscious. The HCPOA allows you to name someone as your agent to make medical decisions for you if you are unable to do so. In California, the advance health care directive also lets you specify your wishes regarding treatment to alleviate pain and donation of organs at the time of death. The advance directive generally goes into effect only if your physician determines that you are unable to make your own health care decisions.
“Creating an advance directive doesn’t have to be difficult,” Hedding says. “There are a number of standard forms available to help you, including a free simple one from the California Hospital Association that is available on Washington Hospital’s website. It’s not necessary to hire an attorney to prepare an advance health care directive, but if you are already using an attorney to prepare your will or a revocable trust, you might consider having the attorney create the advance directive, too.”
The Washington Hospital website also offers a link to “Five Wishes,” a more detailed advance health care directive that also covers the personal, emotional and spiritual needs of the person, not just the medical and legal issues. The Five Wishes form is offered by the nonprofit agency, Aging with Dignity, which charges a fee of about $5 to use the form.
“The most important thing in creating your advance directive is to name the person you want to serve as your agent to speak on your behalf,” Hedding adds. “It’s also a good idea to name up to two alternative agents in case your first choice of agent is unable to make health care decisions for you for some reason. You don’t have to name a family member as your agent if you feel someone else, such as a good friend, would do a better job of speaking for you. In any case, it’s important to make sure all people concerned are aware of your wishes.”
California requires that advance directives be witnessed by two people who know the individual making the advance directive. One of those witnesses cannot be related by blood, marriage or adoption, and neither witness can be the person who is designated as the agent. Alternatively, the advanced directive can be notarized.
“The individual’s physicians, nurses or other health care providers are not allowed as witnesses,” Hedding cautions. “The fact that the hospital staff can’t serve as witnesses to advance directives makes it even more imperative to complete an advance directive before you are admitted to a hospital.”
You can revoke or revise your advance directive at any time.
“An advance health care directive is not cast in stone,” Hedding explains. “The advance directive can always be revised if you change your mind or if your health situation changes. We will follow the instructions in the most recent version of your advance directive.”
Hedding notes that the most common reasons for updating an advance directive are referred to as the five D’s:
- When you reach a new decade in your life.
- If your agent or another person named in the advance directive dies.
- If you divorce.
- When you receive a new medical diagnosis that changes your priorities.
- If your medical condition declines.
A study conducted by the Pew Research Center shows that 71 percent of Americans have considered their end-of-life preferences, and 95 percent have heard of a living will – a type of advance health care directive. Yet only 29 percent of Americans have one.
“Based on our experience here at Washington Hospital, the number of people in our community who have an advance directive may be even lower—somewhere between 10 and 25 percent,” Hedding says. “We’re really trying to increase the number of people who create advance directives to let their loved ones and health care providers know their wishes. The biggest obstacle seems to be that talking about the end of your life with loved ones is a difficult conversation to have.”
(Part 2 of this series of articles on advance directives will discuss how to have “the conversation” with your loved ones about your end-of-life preferences. Part 3 of the series will discuss the spiritual, emotional and cultural concerns that people may want to address in an advance directive.)
Washington Hospital offers assistance to people who wish to create an advance health care directive. The hospital’s Health Insurance Information Service Coordinator, Kristi Caracappa, is available Monday through Friday from 8 a.m. to 5 p.m. by phone or in person. Call (510) 494-7005. Her office is located at Washington West, 2500 Mowry Avenue, Suite 100, in Fremont.
For more information and links to advance health care directive forms, visit www.whhs.com/advance-directives. You also can visit the following websites to learn more about Advance Health Care Directives and the “Five Wishes:” www.calhospital.org/resource/advance-health-care-directive and www.agingwithdignity.org/five-wishes.php.