Do you mind if I ask you a question? Who’s making medical decisions for you, in the event that you are unable to make them for yourself? You might be thinking, but I’m young and healthy… I have plenty of time to think about things like that… just not right now. In light of the fact that tomorrow, April 16, is National Healthcare Decisions Day, I’d like to share a true story with you.
I was in my early twenties, working my first job as an RN. I worked in a sub-acute rehab facility where patients came for skilled therapy or nursing services. Our patients were typically over sixty and recovering from hip replacements, strokes, and other ailments one would associate with an older population. I worked the night shift, and when I went into work one night, a new patient had been admitted to my unit, which wasn’t unusual. What was unusual was her age. My new patient was twenty nine years old and suffered extensive brain damage because of an asthma attack. She was completely unable to care for herself or communicate her needs. Her parents were granted the right to make medical decisions for her. Her fiance strongly believed that the decisions her parents made conflicted with what she would want, but because she’d never completed an advance directive, he couldn’t legally intervene. As I provided care for her, I couldn’t help but think that I never wanted to be in her position. Nor did I ever want to put my family in the position to make decisions for me without knowing what I would want. So, within weeks of her being admitted, I assigned a Durable Power of Attorney to make medical decisions for me in the event that I was unable to make them for myself.
Most people presume that their spouse or their parents will make decisions for them if ever the need should arise. As a nurse, I learned that without a Durable Power of Attorney for Healthcare, loved ones are often limited in the decisions they could make, and there were often disagreements over what the patient would want. Advance directives give you a voice in decisions about your medical treatment, even if you are unconscious or too ill to communicate. While you are well and able to communicate, you can accept or refuse any medical treatment. But if you become seriously ill, you might lose the ability to participate in decisions about your own treatment.
Having a conversation with your loved ones about what you want done in the event you can’t speak for yourself is an important step to assuring that your wishes are honored. Taking it a step further and assigning someone to make important health care decisions for you is something that everyone over the age of 18 should do, because you never know what might happen. My patient surely didn’t think she’d have an asthma attack and lose her ability to make her own decisions.
Starting the conversation about your wishes can be awkward, but it is absolutely necessary and can prevent unnecessary anguish later on. Here’s a few simple steps to get the conversation started…
- Start with your loved ones. Honest communication can help families avoid the stress of guessing what a family member would have wanted. You may find that you and your loved ones may see some things differently. That’s okay. Be open with each other and focus on really understanding the views of those you love.
- Think about what is most important to you. What are your greatest fears, hopes and goals? Who would you prefer to make decisions on your behalf with your physicians if you could not? How sure are you of your choices? Do you want your chosen proxy to have leeway to change your decisions? Discuss these topics with your loved ones to reach a shared understanding of your desires.
- Make it official. Once you’ve had the conversation, formalize your decisions by putting them in writing. There are several ways. An advance directive can help describe your medical wishes when you no longer can. Special medical orders can be developed with your doctor. Finally, a health care proxy identifies your health care agent—the person you trust to act on your behalf if you are unable to make decisions or communicate your wishes.
- Get help. You can find valuable resources to help you think through these issues and make decisions more manageable at theconversationproject.org and agingwithdignity.org.
Once you complete an advanced directive, it’s important to know that they don’t expire. They remain in effect until you change them, so you should review your advance directives periodically to ensure that they still reflect your wishes. I f you want to change anything in an advance directive after you have completed it, you should complete a whole new document.
It’s unlikely that your loved ones are going to ask you what you want done in the event you can’t communicate your wishes (it’s kind of a morbid question), so it’s up to you to take the initiative and express your wishes.