By Marilyn Mitchell

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In emergencies, the default option is to do everything to save the person's life.  But there are situations in which doing that would not necessarily be in the best interest of the person experiencing the emergency situation. For instance, an elderly person had requested hospice care and was nearing the end of their life.  The relative living with them panicked and instead of calling their hospice nurse, called 911. The elderly person was unsuccessfully resuscitated, which caused pain from having their ribs broken during the chest compressions and unnecessary stress at the end of their life. They did not survive. They did have an Advance Directive, but their relative did not follow their wishes to die a natural death. It is very important to choose someone you think will commit to following your desires.

No one plans on getting into an auto accident, yet most adults have been in at least one.  With about 6 million auto accidents annually in the U.S. and hundreds of thousands of injuries, it would seem reasonable for anyone that has a driver's license to be required to create an Advance Directive.  We all get to decide if we want to be organ donors at the DMV; why not also decide to designate someone to speak for us if we are unable to due to an accident?

Creating an Advance Directive may be very important for anyone's future; yet even more important are the conversations you have with family and friends regarding your wishes. That way you will know that several people are able to communicate your wishes. It may not seem like festive holiday banter, but discussions about these issues are becoming more important than ever because we live in an aging society.

Helping a loved one create an Advance Directive if they’ve begun the process of dementia is still possible in the early stages. Most people have fluctuations of their mental abilities as they succumb to dementia. You may recognize that your loved one is more capable of speaking and understanding conversations at certain times of day. Discussing an Advance Directive when that person is at their best time mentally would be ideal.

Discussing one’s Advance Directive with one’s primary care physician is also vital to the process. They can help to explain any misconceptions and answer any questions about treatment. Unfortunately in today’s medical world, primary care physicians are often not the ones in the hospital at your bedside if you’re admitted; it’s often a hospitalist­, a physician that specializes in inpatient medical care. But having had the conversation with your primary care physician is essential for you to feel informed about your choices. That way, if you are admitted unable to communicate, your Advance Directive will have been made with the consideration of information provided by your primary care physician. 

Next. You've created an Advance Directive; now what do you do with it? It's important that it doesn't end up in your safety-deposit box where it will do no good if it's needed. Send a copy to your primary care physician. If your medical system is computerized, it will be scanned and added to your chart. Keep a copy somewhere others can easily find it. Give a copy to the person you named as your 'durable power of attorney for health care.' That way, they will know in advance what your wishes are. It may stimulate even more conversation that could be very helpful if your surrogate is indeed called upon to assist a medical team with decisions for treatment.

 

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