The Growing Urgency of Advance Care Planning: Why Your Wishes Matter
Many of us shy away from thinking about complete-of-life care, but failing to plan can leave a significant burden on loved ones during an already incredibly difficult time. Recent experiences highlight a concerning trend: a lack of preparation, with fewer than one in three adults having completed an advance directive, such as a living will or do-not-resuscitate (DNR) order. This leaves critical decisions about care in the hands of others, potentially leading to outcomes that don’t align with personal wishes.
What Exactly *Is* an Advance Directive?
An advance directive is a set of instructions outlining your preferences for medical care when you are unable to communicate them yourself. It’s not just about end-of-life scenarios; it applies to any situation where you’re incapacitated, even temporarily, like during surgery. These documents typically include a healthcare proxy form – designating someone to make decisions on your behalf – and a living will, which provides guidance on the types of treatment you would or would not aim for.
Who Needs an Advance Directive?
If you’re an adult capable of making your own medical decisions, you can – and arguably should – complete an advance directive. Catastrophes can happen at any age and having a plan in place provides peace of mind. This represents particularly crucial for individuals without a spouse or close family, or those who are estranged from their relatives. It also offers vital protection for individuals whose wishes might not be understood or respected by their families, such as members of the transgender community who may want to specify preferred names, pronouns, and grooming standards for healthcare settings.
Defining Your Values: What Goes Into an Advance Directive?
Experts recommend starting by reflecting on your core values regarding quality and quantity of life. Do you prioritize extending life at all costs, or is maintaining a certain quality of life more vital? Consider what makes life meaningful to you – is it the ability to engage in specific activities, maintain cognitive function, or simply experience joy? These considerations will shape your instructions regarding life-sustaining treatments, palliative care, and other medical interventions.
For those with terminal illnesses, more detailed forms like Physician/Provider Orders for Life-Sustaining Treatment (POLST) or Medical Orders for Life-Sustaining Treatment (MOLST) can outline specific conditions and desired responses.
Choosing the Right Healthcare Proxy
Selecting a healthcare proxy is a critical step. Choose someone who can and will honor your wishes, even if they disagree personally. While a spouse or child might seem like the obvious choice, consider whether they are emotionally equipped to make difficult decisions under pressure. Sometimes, a friend, neighbor, or someone outside the immediate family may be a better fit. Ensure your chosen proxy is willing, able, and understands your values. It’s also wise to designate one or two backup proxies in case your primary choice is unavailable.
Making It Official: How to Create an Advance Directive
Each US state provides free advance directive forms online. Resources like The Conversation Project, The Order of the Good Death, the National Alliance for Care at Home, and MyDirectives.com offer guidance and state-specific forms. While not always required, consulting with an attorney and your medical team is recommended, especially if you have complex wishes or are undertaking broader estate planning.
Keeping Your Directive Current: Regular Review is Key
An advance directive isn’t a “set it and forget it” document. Life circumstances change, and your values may evolve over time. Experts recommend reviewing your directive regularly – some suggest annually or during significant life events like a marriage, divorce, or diagnosis. Re-signing and dating the document after each review confirms its current validity.
Navigating Potential Hurdles
One challenge is the lack of a national database for advance directives, making it difficult for healthcare providers to access them quickly in emergencies. Legislative efforts, like the proposed Legacy Act, aim to address this issue. Some states have laws that can override a person’s advance directive if they are pregnant, raising concerns about patient autonomy.
Starting the Conversation: Encouraging Others to Plan
Talking about end-of-life wishes can be uncomfortable, but it’s a gift to your loved ones. Frame the conversation as a way to ease their burden and ensure your preferences are honored. Resources like The Conversation Project offer guidance on how to approach these discussions. Sometimes, a gentle nudge – or even a playful incentive – can be effective.
FAQ: Advance Care Planning
Q: What if I change my mind after creating an advance directive?
A: You can revoke or modify your advance directive at any time, as long as you are mentally competent.
Q: Do I need a lawyer to create an advance directive?
A: Not necessarily, but it’s advisable if you have complex wishes or are undertaking broader estate planning.
Q: Where should I maintain my advance directive?
A: Keep the original with your important documents and provide copies to your healthcare proxy, doctor, and family members.
Q: What is the difference between a living will and a healthcare proxy?
A: A living will outlines your wishes for medical treatment, while a healthcare proxy designates someone to make decisions on your behalf if you are unable to.
Don’t wait until a crisis to have these important conversations. Taking the time to plan now can provide peace of mind and ensure your wishes are respected when they matter most.
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