6 Tips for Creating an Advanced Directive

April 7, 2017 Doug Wilson, MD


If you were in an accident or became seriously ill and couldn’t speak for yourself, would your family, friends and health care providers know what care and treatment you’d prefer? Would they know what you wouldn’t want?

Creating an advance health care directive is an important step in your life. After all, you’re deciding and documenting your health care wishes, including future medical treatment as well as whom you’d designate to communicate your preferences. You plan for almost every other important even in your life—attending college, getting married and retiring from your career—so why wouldn’t you take the time to plan for your end of life?

If you are part of the 77 percent of Americans who still have not created an advance directive because the topic is so overwhelming, here are six tips that might make it easier for you to get started:

  1. Don’t wait for the “right time.” Doug Wilson, MD, a board-certified family medicine and palliative care specialist with St. Joseph Health Medical Group, says it’s important that every adult—not just someone who is sick or elderly—fill out an advance directive right now. “I talk about it every day with my patients,” he says. “It’s easy for people to put it off because it’s not an emergency … until it is. It’s never the right time until it’s too late, so don’t wait.”
  2. Pick the right person to make your decisions. (Hint: It isn’t always your significant other). “It should be someone you really trust and who is capable of making decisions on your behalf, even if they don’t agree with you. That person may not be your spouse, to some people’s surprise,” says Dan Dwyer, interim vice president of theology and ethics at Queen of the Valley Medical Center in Napa, California.

    In his role, Dwyer has dealt with various end-of-life ethical conversations with families at the bedside of an incapacitated loved one who are struggling with a decision to continue life support or consent for other medical treatment. “You have daughters, sons, spouses and siblings in conflict with one another because their loved one didn’t ever discuss their wishes or create an advance directive,” he says. “It’s really heartbreaking, and it can be avoided.”

    Some people may even decide to designate a health care agent even if they are physical capable of communicating, says Lana Tran, registered nurse and case manager with St. Jude Heritage Medical Group in Fullerton, California. “Some patients are very emotional and have a difficult time conveying their wishes, so they prefer to choose someone else to help them communicate with the care providers,” she says.
  3. Talk with the person you designate as your health care agent, make your wishes clear and, most importantly, get their consent to be the person to make decisions on your behalf, even if they don’t necessarily agree with your wishes. “Sometimes the person we ask can’t deal with it, doesn’t want to have that responsibility, or never agreed with your decisions and didn’t want to tell you so,” says Dwyer. “Be sure the person you choose wants to serve in this role for you.”
  4. Document your wishes in an advance directive—Go to www.talkaboutwhatmatters.org and follow four easy steps—THINK, TALK, CHOOSE & COMPLETE.
  5. Once completed, make sure to give a copy of your advance directive to your decision maker, loved ones and your health care providers and hospital where you receive care.

    Lori Oswalt, director of the Covenant School of Radiology in Texas, says a lot of people make the mistake of keeping a copy on their computer or in a safety deposit box or file cabinet, but forget to give one to their physician. “I had to make some tough decisions for my mother and father at the end of their lives. They had never spoken about their health care wishes. After they died, we found their advance directives and realized we might not have gone as far as we did to prevent their death if we’d had it in our hands when we needed it,” she says. “When you have a loved one dying, you’re in such turmoil and you just want to do the best for them.”
  6. Review and update your advance directive. Think of it like an annual physical exam, and review and update it, if necessary. “Originally, I didn’t want to be cremated after I died, but I’ve changed my mind,” says Larry Hattem, 83, who is an advocate for advance directive planning at St. Joseph Hospital, Orange. “I go back and read my wishes every so often, and make changes to it as my thoughts evolve over the years.”

Once you’ve created your advance directive, you’ll rest easier, says Oswalt. “People always say they’re going to ‘get to it’,” she says. “Just do it – because you’ll never know if you’ll be in a situation where you need it. And, after you’ve done it, it gives you and your loved ones a little peace of mind knowing someone knows what you would want if you can’t speak for yourself.”

This information is not intended as a substitute for professional medical care. Always follow your health care professional's instructions.



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