Advance directives help patients spell out healthcare decisions
Parkland officials encourage discussions before crises occur
Claudia Hayes remembers the day she opened her mail to find a signed copy of her mother’s Directive to Physicians, Family or Surrogates (Living Will) and Medical Power of Attorney. Although the documents, also known as advance directives, weren’t something the two had previously discussed, Hayes wasn’t surprised that they had been executed.
“My mother was the type of woman who made sure everything was taken care of, down to the smallest detail,” Hayes said. “When it came time to make difficult healthcare decisions, she wanted to make sure the burden didn’t fall on us.”
Advance directives are legal documents that allow you to spell out your decisions about end-of-life care or indicate who you want to make these decisions if you are unable. By planning ahead, you can get the medical care you want, avoid unnecessary suffering and relieve caregivers of decision-making burdens during moments of crisis or grief. You also help reduce confusion or disagreement about the choices you would want people to make on your behalf, according to Linda Wilkerson, Director of Parkland Health & Hospital System’s Pastoral Care department.
Advance directives aren’t just for older adults. Unexpected end-of-life situations can happen at any age, so it’s important for all adults over the age of 18 to prepare the documents. In addition, copies should be given to your family and to your healthcare provider.
There are four types of advance directives including a Directive to Physicians, Family or Surrogates (Living Will), Medical Power of Attorney, Declaration for Mental Health Treatment and Out-of-hospital Do Not Resuscitate (OOH DNR).
A medical or healthcare power of attorney is a type of advance directive in which you name a person to make decisions for you when you are unable to do so. In some states this directive may also be called a durable power of attorney for healthcare or a healthcare proxy. The person you name may be a spouse, other family member, friend or member of a faith community. You may also choose one or more alternates in case the person you chose is unable to fulfill his or her role.
A directive to physicians is a written, legal document that spells out medical treatments you would and would not want to be used to keep you alive, as well as other decisions such as pain management or organ donation.
“In determining your wishes, think about your values, such as the importance to you of being independent and self-sufficient, and what you feel would make your life not worth living,” Wilkerson said. “The questions you should ask yourself are, ‘Would I want treatment to extend life in any situation and would I want treatment only if a cure is possible?’ These are tough questions to ask yourself, but it’s better than leaving family members to try to figure out what you may have wanted, especially if you’ve never discussed it.”
Another form to consider is the Out-of-hospital Do Not Resuscitate. The OOH DNR is a form signed by the patient or proxy and their physician stating you do not want any life-sustaining treatments in the hospital or doctor’s office, at home or in an emergency vehicle.
“No one expects or plans to end up hospitalized in a burn center or to suffer a trauma. Things can happen quickly and unexpectedly, and they can happen to anyone, even young people. Patients with severe burn injuries often need to be quickly placed on a ventilator and are sometimes very sedated, making it difficult for them to clearly communicate with hospital staff or participate in decisions regarding their own care,” said Stephanie Campbell, BSN, RN, CCRN, Program Manager in Parkland’s Regional Burn Center.
“Advance directives help the medical team understand the patient’s wishes and they also provide support to family members as they work with the medical team. Families are often burdened with decisions about invasive but potentially life-saving treatments and they have to ask themselves what the patient would want,” Campbell added. “I’ve seen how difficult these questions can be for families in the burn center, especially when the patient is older in age or had other health problems prior to the injury. Advance directives have the ability to remove some of this uncertainty and at least partly relieve the stress of decision-making for family members during a very upsetting time.”
“Even though we never discussed the advance directives, I am eternally grateful that my mother had the presence of mind to do them,” Hayes said, noting that she and her husband, as well as other family members have also completed the forms.
For more information about these forms, see our guide to making health care decisions in advance.
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