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Do You Have an Advance Directive?

David Spero

May 1, 2013

I’m working on my advance directive for health care, or “living will.” Why? Because an essay called “How Doctors Die” convinced me I need to get this done right away.

An advance directive (AD) is one of the most valuable self-management things a person can do. It could save you and your family huge amounts of unnecessary grief, suffering, and expense.

ADs tell the medical system what you want and don’t want done to prolong your life. Without an AD, doctors feel they have to do “everything,” even things they know won’t work. They’ll be afraid of being sued if they don’t.

You don’t want to be the patient in that situation. According to Dr. Ken Murray, who wrote the essay, almost no sick or elderly person gets well after cardiopulmonary resuscitation (CPR). He says out of “hundreds of patients” he treated in Emergency Rooms who had CPR, “exactly one [eventually] walked out of the hospital.” And that one was a young man with no heart problems. A few others may have left in wheelchairs to go to nursing homes, but most just ran up huge hospital bills and died.

According to Dr. Murray, if you’re young and healthy, CPR is worth a shot. But “if a patient suffers from severe illness [or] old age,” he says, “the odds of a good outcome from CPR are infinitesimal.” You’ll have to decide where you fit on that spectrum.

I personally gave CPR to probably 20 patients when I worked in medical wards, and none of them lived to leave the hospital, although some made it to Intensive Care. I can only shudder when I think of what those useless, cruel, rib-fracturing treatments may have cost their families.

You can prevent this trauma by putting your wishes in writing and designating a trusted agent to carry your wishes out. The two main kinds of advance directives are the durable power of attorney for health care decisions and the individual instructions (or living will). They sometimes overlap.

According to Caring Connections, a program of the National Hospice and Palliative Care Organization, a medical power of attorney is most important. This allows you to appoint someone you trust as your agent to make health-care decisions for you when you can’t.

A living will spells out what you want and don’t want, but without someone to advocate for you (be your attorney), what you want probably won’t happen.

When you have chosen an agent (and maybe an alternate agent if the first one is unavailable or unable), you have to sign the form in front of witnesses. Then you have to make sure the agent, your doctor, your hospital, and you have copies. Some states and the federal government also have advance directive registries that hospitals can check. File your directive with them, too.

You need to have an honest heart-to-heart talk with your agent. Make sure he understands and is willing to carry out your wishes. Caring Connections says it’s also important to talk with your family and close friends, so that everyone can be on the same page.

This talk is likely to be emotional and a bit scary, which may be why two thirds of adult Americans do not have advance directive. It’s also very important to discuss your wishes with your doctor(s). Advance directives may also include wishes about organ donation.

I have to wonder why haven’t I done this before. I’m much more scared of the medical system than I am of dying. I’ve written about that a lot on my blog Reasons to Live. So what’s holding me up?

Actually, I did have an AD about 20 years ago, but I changed doctors and moved apartments, and it got lost. (That happens a lot to ADs.) Then I stalled on redoing it. So far I’ve been lucky, but I will have one done, witnessed, copied, and handed out by next week, I promise.

Having a living will or advance directive doesn’t mean “no treatment.” You can still have any treatment your doctor and your agent agree to or request. The American Bar Association has very useful information about advance directives at this Web site (PDF).

Two final points — ADs are not just about CPR. They could also apply to surgeries, dialysis, feeding tubes, or anything else you don’t want. And if you don’t want CPR and you’re not breathing, don’t call 911. By law, EMTs have to resuscitate in most states.

So do you have your AD in place? Why or why not? Does your family know, and do you have an agent you trust? How did you do that? If you want an AD, you can download a form and instructions here.



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