Crossroads University - Caring for the Paperwork - Advance Medical Directives

Advance Medical Directives

Caring for the Paperwork

Crossroads University

Caring for the Paperwork

Advance Medical Directives

When your terminally ill loved one is too sick or mentally unable to express their wishes concerning health care, legal documentation known as advance medical directives are used to determine their care concerning many end-of-life issues. Having advance medical directives in place for your loved one ensures that their wishes concerning their health care and end-of-life care are met according to their specifications.

What are the benefits of creating advance medical directives?

While the task of preparing documents concerning your loved one’s health care can seem overwhelming, the benefits of having advance medical directives cannot be overstated.

  • Advance medical directives provide peace to families during a stressful time. Family members, seeking to help, may argue with medical staff or other family members concerning the interpretation of their loved one’s end-of-life care preferences. With advance medical directives in place, family members can rest assured that their loved one’s wishes are being followed to the letter by healthcare professionals.

  • Advance medical directives give clear instruction to medical professionals. With your loved one’s wishes clearly stated, healthcare professionals can focus their efforts on providing the best care for your loved one in direct accordance with your loved one’s preferences.

  • Advance medical directives ensure that your loved one has the end-of-life care that they desire. There may be many options concerning the administration of medications, treatments, and procedures during your loved one’s end-of-life. These options, once understood, may be in direct conflict with your loved one’s beliefs or care preferences. By having your loved one’s wishes expressly stated, you are assured that your loved one’s preferences are known during their end-of-life care.

What kinds of advance directives are there?

Advance directives come in two primary forms in the United States: the durable healthcare power of attorney and the living will.

Durable Healthcare Power of Attorney

A durable healthcare power of attorney document is a legal agreement that specifies who can make medical decisions on behalf of your loved one if their mental capacity or communication is jeopardized. This selected person is known as the “health care agent,” “attorney-in-fact,” or “health care proxy.” Consider the following criteria when helping your loved one select who they wish to appoint as their health care agent:

  • The selected health care agent must be at least 18 years old.

  • The health care agent must be able to make potentially difficult decisions in the presence of medical professionals and family members.

  • The health care agent must be one who is trusted to have the best wishes of your loved one in mind at all times.

Living Will

A living will dictates to healthcare professionals what your wishes are concerning medical treatments, procedures, or equipment that can assist in sustaining life. Within a living will, your loved one can specify the care they wish to receive during their end-of-life. Some of the more common options covered in living wills include the following:

  • Use of feeding tubes, catheters and forms of intubation

  • Use of life support devices and care practices

  • Donations of tissues, organs, or other portions of their body after death

  • Use of medications to alleviate pain or reduce symptoms

  • Use of resuscitation if breathing, heartbeat, or brain activity stops

  • Deactivation of ICDs or pacemakers

How can I help my loved one create Advance Medical Directives?

Have the conversation

Starting a conversation surrounding death and dying can be difficult; however, it is a necessary step in helping your loved one specify their healthcare wishes. The following methods can prove effective when trying to get the conversation started with your loved one:

  • Creating your personal advance directives, and asking for your loved one’s help, allows you to lead by example. While developing your advance directives, you can ask for your loved one’s input on your decisions for your personal end-of-life care. In discussing your wishes for your health care, you can begin to talk to your loved one about creating their advance directives.

  • Having a conversation about major life transitions can be a useful segue into discussing advance medical directives. The filing of a will, moving to a care facility, or a retirement can naturally allow end-of-life conversations to occur.

  • Discussing the experiences of others’ end-of-life care can help open the door to a discussion concerning your loved one’s health care preferences. The experiences of family members and close friends can serve as a reminder as to why specifying medical directives ahead of time is important.

Understand and discuss the potential treatments, medications, and procedures

As your loved one’s terminal illness progresses, there may be a host of different treatments, procedures, and medications available to them for their specific illness. Ask your loved one’s physician regarding the medications and treatments that may become available and what impact they may have on your loved one’s comfort at the end of life.

Once you understand the options available, discuss these potential treatments with your loved one. Your loved one may have religious, moral, or personal convictions regarding the use of certain medications and treatments. Discussing these specific treatments and your loved one’s thoughts concerning their use allows you to help them craft advance directives that ensure their exact wishes are carried out.

Obtain and Complete the Documentation

Many health-based organizations in your area can supply you and your loved one with advance directive forms specific to your state. Medical organizations and healthcare professionals that may supply these forms include:

  • Doctors’ offices

  • Your state’s Agency on Aging

  • Law offices that specialize in legal matters concerning health or senior care

  • Hospice programs

  • Hospitals

In the United States, each state has different advance directive forms and laws that govern their validity. You and your loved one can complete the forms, and you do not require a lawyer to assist in the preparation or completion. Though a lawyer is not required to create advance medical directives, it is wise to seek professional legal counsel when creating advance medical directives. A lawyer can help your loved one properly declare their end-of-life care preferences according to state laws.

Distribute the Directives

With the advance directives completed, you can assist your loved one by distributing the directives to those involved in the care or legal dealings of your loved one.

  • Physicians, nurses, and other medical personnel can use your loved one’s advance directives to ensure that they are administering care that is meeting your loved one’s specifications.

  • Hospice organizations can use the information in your loved one’s directives to ensure that the hospice team is kept up-to-date with your loved one’s care preferences concerning medication and treatment.

  • Your loved one’s lawyer should be given a copy to ensure they are made aware of your loved one’s end-of-life care specifications. Should any litigation arise before or after your loved one’s death concerning their treatment, having the directives in the hands of legal professionals can help prevent confusion and offer clarity to the situation.

Keep the Directives Updated as Needed

Over time, certain items covered on your loved one’s advance directives may require updating. Advance directives, once created, reflect your loved one’s wishes for their end-of-life care at a certain point in time. As your loved one progresses on their end-of-life journey, they may change their mind concerning the use of certain treatments, procedures, and medications.

  • Your loved one may learn new information about medications, treatments, or procedures that influences their previous stance on the issue.

  • Your loved one may have a shift in religious or ethical views concerning specific treatments.

  • New medications or treatments may become available that your loved one wants to incorporate into their end-of-life care preferences.

Once the updated advance directives have been completed, contact those who have been given the previous version of your loved one’s advance directives. Inform them that new versions have been developed and will be sent to them. Direct them to destroy any previous incarnations of your loved one’s directives.

When helping your loved one navigate their end-of-life journey, having medical directives in place offers stability, clarity, and understanding for everyone involved. Medical professionals can provide your loved one with medical care that is in alignment with your loved one’s wishes, and can make decisions focused on providing the highest levels of care and comfort. Your family can rest assured that medical personnel clearly understand your loved one's wishes. Most importantly, your loved one is given the assurance that their end-of-life care is exactly what they desired, providing them with comfort and peace on their end-of-life journey.

References

  1. Ewer, Michael. "Advance Directives in the Intensive Care Unit of a Tertiary Cancer Center." Http://onlinelibrary.wiley.com/doi/10.1002/1097-0142(19951001)76:73.0.CO;2-U/epdf. American Cancer Society, 1 Oct. 1995. Web. 1 May 2015. <http://onlinelibrary.wiley.com/doi/10.1002/1097-0142(19951001)76:73.0.CO;2-U/epdf>.
  2. Rosenfeld, Kenneth E., Neil S. Wenger, and Marjorie Kagawa-Singer. "End-of-life Decision Making." Journal of General Internal Medicine. Springer-Verlag, 1 Sept. 2000. Web. 1 May 2015.