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Published: July, 2014; Vol 11, Num 2

Advance Directives: Road Maps for the End of Life

Many people are shrinking violets when it comes to dying. They don’t even want to think about it. They might do some estate planning and may even select a burial site, but will often leave how they are going to live their final days and hours to chance. This can cause problems, particularly if, when that time arrives, they are no longer able to communicate. When that happens, a family member or loved one must decide what should be done. What they think is best may not be what the person would want.

Advance directives – written instructions about medical care preferences – help assure that decisions made on your behalf are in line with your wishes. Advance directives can state the medical treatments you are willing to receive, such as artificial feeding, the use of ventilators and antibiotics and whether you want to be kept alive for as long as possible. They can also state what treatments you do not want if you are never going to fully recover or, should you have a progressive condition like cancer or dementia, whether you want hospice care.

Advance directives can also help reduce the stress on your loved ones. Confusion, disagreement and guilt are less likely when family members aren’t making care decisions for you that are based on guesswork.

Advance directives are something that every adult should have. Illness and accidents can happen to anyone at any time. Regardless of your age, it is important to have written and accessible plans in place that clearly explain the type of care you want.

Advance directives include:

  • Living will: Spells out the medical treatments and life-sustaining measures you want and don’t want. Health care declarations or health care directives are other names for living wills.
  • Medical or health care power of attorney (POA): Designates an individual − referred to as your health care agent or proxy − to make medical decisions for you in the event that you’re unable to do so for yourself. A medical POA is different from a financial power of attorney, which gives someone the ability to make monetary transactions for you.
  • Do not resuscitate (DNR) order: This is a request to not have cardiopulmonary resuscitation (CPR) if your heart stops or if you stop breathing. Your doctor can put a DNR order in your medical chart.

An attorney can help you draw up advance directives that are specific to your wishes. You can also prepare them on your own by downloading the appropriate forms online. Forms that are specific to your home state can be accessed by going to www.caringinfo.org and searching under the "Planning Ahead" section. (In Canada, most provincial governments provide sample forms on their websites.) After you’ve filled them out, make copies, keep them in an accessible place – never in your safety deposit box – and let your family know where they are. My Health Care Wishes is a free smartphone app that allows you to store your advance directives on your iPhone or Android phone. You can also make these documents accessible through the web using free services such as MyDirectives, through email or by filing them in a cloud-based storage system such as Dropbox. You should also keep hard copies in your wallet or pocketbook. Review your advance directives every few years to make sure they still address your needs.

Planning for the end of life is never easy, but doing so can bring you peace of mind. It is also one of the most loving things you can do for those you are leaving behind. Advance directives are the best way of assuring that when your time comes, your needs and the needs of those you care about the most will be met.

[Janet Lubman Rathner]