Advance directives can bring peace of mind

Advance directives are important to consider, even for the young and healthy.

It’s a topic that 92% of Americans say is important to discuss, yet only 32% have had such a conversation, according to The Conversation Project.

End-of-life care can be difficult to talk about and plan for, but an advance directive is the best way to ensure one’s wishes are understood and respected.

“Every person needs to think about how they want to be cared for if a terminal illness or catastrophic event occurs,” said Dr. Uday Jani, a highly respected internal and integrative medicine physician based in Milton. “People often delay planning for this if they’re healthy, but life is unpredictable, and you never know when it might take an unexpected turn. Everyone has peace of mind knowing what healthcare providers and facilities will be better equipped to address healthcare planning issues before a crisis, and better able to honor patient wishes when the time comes to do so.”

Over more than 30 years of practice, Jani has witnessed the unfortunate results of what frequently happens at the hospital when there is no advance directive for a patient.

“In the absence of guidance from the patient, it’s a real struggle for families and healthcare providers to make these difficult life-and-death decisions on their behalf. Each member of the family has a different opinion of what should and should not be done, and they may not be aware of their loved one’s wishes,” he said. “It’s why I encourage all my patients to create an advance directive document so there is no question as to whom they authorize to make medical decisions for them when they can’t, and what type of medical treatments they want.”

Jani recommends a thoughtful approach to healthcare planning, starting with each person’s careful reflection of what matters most to them.

Consider these questions from the founders of National Healthcare Decisions Day, an initiative held annually each April to encourage and guide people through the advance care planning process:

What abilities are so critical to your life that you want to keep going as long as you retain them? For example, “As long as I can at least sit up and occasionally talk to my grandchildren” or “As long as I can recognize my loved ones.”

What do you want to make sure doesn’t happen at the end of life? For example, “I don’t want to become a burden on my family,” “I don’t want to be alone,’” “I don’t want to end up in the ICU on a lot of machines” or “I don’t want to be in pain.”

If your illness is terminal, which matters to you more – treatments that offer the possibility of gaining more time, or having a better quality of life? Do you want doctors to do absolutely everything they can to keep you alive, or do you want them to offer comfort care only?

Are there kinds of treatment you would want or not want, such as resuscitation attempts, ventilation or feeding tube?

“Thinking through these questions will help you clearly communicate your wishes to your healthcare proxy or agent – the person you will be asking to make certain decisions on your behalf,” said Jani.

This can be a spouse, adult child, relative, close friend or trusted adviser who confirms they are willing to be responsible for ensuring your wishes are followed. The proxy doesn’t need to be a medical expert but will have permission to talk with your doctors, read your medical records and have the legal responsibility to make decisions about tests, procedures and other treatments. They should be comfortable advocating on your behalf, and fully understand and respect your wishes for end-of-life care, even if different from their own.

“Discuss these responsibilities at length with your proxy beforehand and select someone who is emotionally prepared to make what can be some very tough decisions regarding your care,” said Jani.

In addition, ask more than one person to act as your healthcare agent. “For instance, you may designate your spouse as first agent, but if you are both seriously injured in a motor vehicle accident together, you’ll need an alternate agent to make decisions for you,” he said.

Make sure to document your wishes by creating an advance healthcare directive. This legal document includes the power of attorney for the people you name as your healthcare proxies, a living will with specific instructions on how you want to be treated and cared for at the end of your life, and your wishes regarding donating your body, organs and tissues after death.

“It’s important to note that the advance directive is a legal document, and not a medical order used by doctors, emergency medical technicians or hospitals to treat you in an emergency situation,” said Jani. “For this reason, we advise those who are seriously or terminally ill to also fill out the new Delaware Medical Orders for Scope of Treatment document, which travels with you if you are moved from one healthcare setting to another.”

At home, Jani suggests placing the DMOST form prominently on the refrigerator so paramedics can easily see it if a person is unconscious or unable to talk during an emergency. They’ll need to know immediately if an individual has requested that no life-sustaining measures such as intubation, cardiopulmonary resuscitation, feeding tubes or antibiotics be used.

It’s important to discuss, share and sign off on an advance directive, living will and when needed, DMOST, as well as file them with one’s personal physician as well as a healthcare attorney, advises Jani. And his advice for those who miss National Healthcare Decisions Day April 16 is: Don’t wait until next year to begin the process.

“There’s no better time to start than right now and ensure you are cared for in the final stages of life according to your most deeply felt wishes,” said Jani.