Advance Directive for Health Care

When difficulty comes, we need an action plan, but for many planning doesn’t begin until the bell begins to toll. One of the things we can do in advance is prepare for the future when it comes to our parents’ care and especially if they end up in hospice care. Even now, when we enter the hospital for minor surgery, we are asked to provide an Advance Directive for Health Care. For some this a scary document but it doesn’t have to be. One client asked me to explain this document to her since her mother had just been placed under hospice care.

Several years ago my own mother was admitted to hospice care. The support they offered to her and our family was invaluable. This type of document is a part of the process and is provided for the patient to have input in his or her final healthcare.

Only about 24 percent of the adult population has an advance directive. There are many reasons why this number is so low: education (try as we might, the forms are very “legalese”); lack of awareness (even though most states promote their use); disability (there are a variety of disabilities which would act as a barrier to completing the form).

The objective of the advance directive is to help each one of us better understand the desires and preferences of our parents, spouses, and friends regarding medical care as they approach the end of this life. Observational studies suggest that family members are rarely able to predict end-of-life treatment preferences. The advance directive will clearly state our loved one’s preferences, while removing much of the “what if” burden.

The Advance Directive for Health Care is also referred to as a personal directive. It is a set of written instructions that specify what actions should be taken for an individual’s healthcare needs and end of life decisions, if the loved one is no longer able to act on his or her own due to illness or incapacity. The instructions appoint another person – an agent – to make such decisions on their behalf.

Also, the Advance Directive for Health Care combines two legal documents into a single document: the living will and the durable power of attorney for healthcare. A living will is a legal document in which a person makes known their wishes regarding withholding or withdrawing life support and accepting or refusing nutrition and/or hydration. The durable power of attorney for health care authorizes an agent to be appointed to carry out healthcare decisions when an individual is incapacitated.

I personally feel that the Advance Directive for Health Care is a necessary document for everyone’s estate plan. Advances in medical care and technology have prolonged life expectancy. Additionally, many individuals survive illnesses or traumatic injuries that previously would have been fatal. For many, medical technology only serves to prolong survival in an unacceptable quality of life.

This document also should be periodically reviewed. For an advance directive to be effective, it must reflect what a person would want done for them at some point in the future. However, preferences may change over the course of time or an illness. The preferences need to be revisited, and an advance directive should be updated to reflect changes. When these documents are in place, family members can be much more attentive to the personal care of their loved ones apart from the pressure of making perhaps the most difficult decision a loved one can make.

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