Advance Care Directives: What You Need to Know
Debbie Feldman JD, LCSW
Administrator, Family Care Services for Calvary Hospital
Nobody likes to think about it, but sometime in the future, you or an important person in your life may become very sick or injured, and be unable to make decisions regarding medical care. Whether from an accident, a surgical complication or severe illness, if you couldn’t speak for yourself, who would you want to speak for you? I would advise everyone 18 years and older to complete an Advance Care Directives document to answer that question. While the subject may be uncomfortable to discuss – in many cultures it is even considered taboo – in our contemporary society, it is imperative that you do so. I urge you to please take a moment and understand why it’s important.
While your close friends and family members may know you well and have your trust to make the best decisions for you in a given medical situation, it is always better to have designated a surrogate decision-maker by filling out a New York State Proxy form. This form, also known as an Advance Care Directive, lets you express your medical care wishes in advance and appoint an agent to speak for you if you cannot speak for yourself. When a medical crisis occurs, a person is often unable to make decisions on their own. Taking care of Advance Care Directives, by appointing a Health Care Agent and filling out a Living Will, assures that your surrogate decision-makers have a full understanding of your wishes. Ideally, you want to do this long before you need to, so that your appointed decision-makers have the opportunity to discuss your wishes with you, in order to respect and follow your preferences for care.
Talking about Care
It is important that you, your loved ones and doctors have a regular discussion about Advance Care Directives. As we age, our views and personal opinions change, along with our quality of life ideals and our hopes and expectations for our personal medical care. By completing your Advance Care Directives, you, your family and your medical team will have a better understanding of your health care preferences. This information will alleviate some stress for your designated agents. It’s best to have this discussion when surrogates are unencumbered by the concern of a medical condition with unknown consequences.
Your Wishes and Your Care
Research suggests as many as two-thirds of all American adults have not completed their Advance Care Directives. Lacking an appointed surrogate can cause discrepancies between your wishes and the care you will receive at the end of your life. You may clarify what type of treatments you would like even at the end of life. With your doctor, you will be able to think through common circumstances and define your care goals. You may choose to focus on treatments that improve your comfort or sustain you physically in a given medical situation, or you may choose whether you would\ like to stop a particular type of treatment that may cause a significant side effect. Many studies show that focusing on symptom control does not generally shorten life. Instead, reports have shown that improving the patient experience allows a person to enjoy a sense of peace and calm. What is important to you?
Know Your Care Options
Make sure you take into consideration what special physical, emotional and psychosocial needs you want included in your care. Evaluate what support can be provided by family and friends. Then discuss your thoughts and feelings with your healthcare team or social worker. Take time to understand your options, ask questions, and build familiarity with common terms and conditions.
Advance Care Directives and End-of-Life Care Planning
Decisions about your care should be based on your personal values, preferences, and discussions with your loved ones. At Calvary Hospital we meet patients every day who have not completed their Advance Care Directives and wish they had. It is because of this experience, we urge you to start this conversation with your healthcare team, family and loved ones today.
Plan in Advance
To plan properly, you should:
- Talk about your health and your wishes regarding your end of life care.
- Make this an ongoing conversation so that you have time and support to think through your options.
- Identify what is most important to your future health care in a number of common scenarios.
Prepare for Today & Plan for Tomorrow
Advance Care Directives and end-of-life care planning are not just for the elderly. Don’t wait to complete your form – you can’t predict when an accident or injury might happen. This subject is difficult to think and talk about; however, it is also extremely important. We hope you will take the time to speak with your doctor and family to explore your feelings on this subject. A great place to start is assessing what your ideals are surrounding your care in a wide range of circumstances. Beginning this process is uncomfortable, but it will save the people you care about most, as well as your physician and social worker, from making decisions that are not congruent with your medical healthcare decisions. With Advance Care Directives in place, you can choose and remove the uncertainty from the hearts and minds of the people who love you… and yourself.