Do you know what an advance directive is, much less whether your senior (or you) has one somewhere — or should?
An advance directive is defined as a written statement of a person’s wishes regarding medical treatment made to ensure those wishes are carried out should the person be unable to communicate them to a doctor.
Helping your senior loved one execute an advance directive, or doing it for yourself or with your spouse/significant other, is important for everyone involved.
It won’t be helpful to wait until a crisis occurs to decide one might be necessary.
Setting them in advance of the need is the best way to ensure the desired care decisions are made.
As a matter of fact, it will be too late if you wait until it is needed.
Advance Directive Considerations
When an individual is contemplating preparing advance directives, there are some things to consider.
- Who do they want to make decisions for them if they become unable to express their own wishes for care and treatment?
- Is there a second person they would choose to act as alternate in case the first person is unable, unwilling or unreachable when an emergency occurs?
- What kind of decisions do they want their representative to make? Legal? Financial? Medical? Do they prefer different people make different ones, such as different children?
- What do they want done if they become a victim of illness or trauma? How in depth do they want to be treated?
- If they are in a coma, what care do they want performed? Artificial respiration? Feeding tubes? For how long? Resuscitated? Put on life support? Physician’s assessments?
- If they become disabled and their representative deems, based on medical advice, they will have a poor quality of life, do they want to be revived?
- If they are put onto life support, how would they want the decision made to remove it, if at all?
- If they are dying, what kind of care do they want? Comfort care and pain control only? Intensive care? Care at home? Do they want to be transferred to a hospital?
- Are there facilities where they prefer — or refuse — to go for treatment?
- If they are dying, do they want pain relief even if it reduces their alertness or makes them unaware of their surroundings?
- Do they want someone with them when they are dying? If so, who?
- What kind funeral and burial arrangements do they want? Are there specific desires such as clothing, burial location, music or prayers that they want?
Types of Advance Directives
There are several types of advance directives. You should consider checking with an elder law attorney to ensure that they are executed according to the laws in your state. For example, witnesses are needed but each state varies on number and relationships to your senior, so get the information you need before these documents are executed.
The most well known and oldest type of advance directive is the living will. This document directs the physician to withdraw or not perform medical interventions if your senior is in a terminal condition and unable to make decisions about their own medical treatment.
Some living wills are specific to treatment modalities, such as tube feeding for nutrition or IVs for hydration, and others are non-specific.
They may read something to this effect: life-sustaining measures that would serve only to prolong my dying be withheld or discontinued.
Healthcare Power of Attorney
Another type of advance directive is the power of attorney for healthcare or healthcare proxy. In this document one designates a person to make health care decisions if they are temporarily or permanently unable to make their own decisions.
Your senior doesn’t have to be in a terminal condition for the representative to be asked to make decisions. The person designated needs to be informed about what is desired and strong enough to dictate to health professionals that the wishes be upheld.
Not everyone can be strong in a crisis so this person should be chosen carefully.
Durable Power of Attorney
A durable power of attorney differs from a healthcare power of attorney in that it often includes the ability to perform financial transactions in addition to medical decisions.
This power can be helpful if this person needs to apply for benefits for your senior such as Medicaid while your senior is medically compromised.
The Five Wishes
A list of wishes outside the realm of legal medical wishes is The Five Wishes. This is a special document that goes more indepth about what your senior (or you) would want to happen in a variety of instances, such as having the family pet on their bed at the end of life or who should be called to their bedside, what type of music they want played in the room, and a myriad of other desires for comfort and peace in addition to the medical wishes.
The Five Wishes is a loving picture of the person your senior loved one is, how they want to face the end of their life, and how they want their family to be part of this journey.
Busting Advance Directives Myths
Many people across the country, no matter their culture or upbringing, hold misconceptions about end of life and advance directives. Let’s dispel some of those misconceptions — and myths — now.
- No one, including healthcare personnel, can force your senior loved one to complete an advance directive. It is a voluntary action.
- Doctors and healthcare personnel will not stop treatment or refuse life saving measures, such as antibiotics or intravenous fluids, because there may be a Do Not Resuscitate (DNR) order. If something can be done without heroic measures, they will do it. Advance directives do not mean “do not treat.”
- A Do Not Resuscitate (DNR) order means that if your heart stops beating or you stop breathing, no chest compressions or other heroic measures, such as intubation, will be performed. CPR, cardiopulmonary resuscitation, will be done in the absence of a DNR order. In many states, EMS will perform CPR in transit.
- Advance directives are not irrevocably written in stone and can be rescinded if the subject of the directives has a change of mind in the future. Advance directives are documents detailing healthcare wishes — and wishes may change. (Actually, it is a good idea to review advance directives on a regular basis to be sure they continue to be appropriate. Does your senior still want to be buried or do they now wish to be cremated? Do they want the firstborn to be in charge or the youngest child?)
- The personal representative can be changed if life changes occur, such as divorce, death or conflict. The person just needs to properly update their advance directive as needed.
- Family members can not interpret what your senior loved one “meant” in their advance directives. The physician must decide the wishes of your senior based on the document so be sure wishes are clearly stated and the family knows what is expected.
- It is true that without any advance directives, a physician may choose to perform any interventions and make critical decisions for your senior or a court may appoint a guardian who is unfamiliar with their values and wishes. This may lead to some treatment that they do not want.
Importance of Advance Directives
Advance directives allow your senior loved one the right to die with dignity, using their definition of dignity.
Once seniors have decided what they would like to happen as they age and are near the end of life, ensure family caregivers and family members know your senior’s wishes so they can carry them out without confusion or indecision.
It is also important to provide copies to key individuals such as the power of attorney, family members and physician. The forms should be accessible in case of emergency.
Being prepared is the ultimate gift to the whole family and to oneself.