Advance directives take the guesswork out of medical decision-making for your family.
If you ask people about what type of care they want at the end of life, most folks have an opinion. In 1991, a federal law required health care organizations to inform people about their right to make their wishes known in advance. Despite efforts from people both in and outside of health care, only about 20% of eligible people create an advance directive. Why is that?
One obvious reason is most people don’t want to think or talk about serious illness or death until they have to. Strangely, people are more willing to pay a lawyer to draw up a will to make decisions about what happens to their money and possessions after their death than to complete a free document that gives them control over what happens to their bodies while they are still alive.
Another reason is an advance directive asks people with no medical knowledge to make very important decisions, usually long before anyone knows what end-of-life situation might arise. If you were asked what wallpaper you want in a room of a future house you have never seen, you wouldn’t be able to make a good choice. So how can you decide about care for what might happen in 10 or 20 years? Unfortunately, if you don’t prepare anything, you could end up with treatments and situations that you would find “a fate worse than death.” And your family could be stuck guessing what to do, feeling guilty no matter what way things go.
What’s the solution? If you already have some health issues, you should talk to your doctor about what to expect in the future and consider completing a full advance directive. But if you are young, healthy or simply aren’t ready to make any firm decisions, the most important thing you can do is to name a health care decision-maker. In Vermont, this is called a health care agent. You should talk to this person about what is important to you so that they can express your wishes in a crisis even if you cannot express them yourself.
In addition to talking with your health care providers, there are also online resources that can help you think through decisions about specific treatments. Choosing Wisely (www.choosingwisely.org/patient-resources) and the Ottawa Hospital Research Institute (decisionaid.ohri.ca/AZlist.html) are two reputable sources of evidence-based patient education on a wide variety of medical treatments, including topics relating to end of life.
If you would like free, local help with appointing an agent or creating a full advance directive, reach out to the Advance Directive Volunteer Explainer program at (802) 776-5502 or (802) 747-3608.
This week’s Health Talk was written by Eva Zivitz of the Palliative Care Program at Rutland Regional Medical Center.