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September 26, 2012 at 10:12 AMComments: 1 Faves: 0

Advance Directives: A Life Necessity

By Jeffrey VanWingen M.D. More Blogs by This Author

The Case of Mr. Johnson

Mr. Johnson was in the hospital again, but this time was different. The medicines were not working this time to improve his breathing. He was working harder to breathe and becoming confused. Decisions needed to be made. He was surrounded by some of his children, but in his mind, Mr. Johnson longed to be with his wife, who had passed a few years back.

The doctor entered the room - something needed to be done one way or another. It would be the ventilator machine or simply care focused on keeping him comfortable. Mr. Johnson was not in a condition to make the decision, and it would fall on his family. Though he didn't like giving up, the doctor was seriously doubtful that Mr. Johnson would ever get off the ventilator and felt it would keep him alive unnecessarily.

He recalled vaguely Mr. Johnson mentioning that he never wanted to be kept alive by a machine, but there was nothing in writing. The children nodded in understanding and seemed to agree that dad would want to go peacefully and not be placed on the ventilator. They called their other sibling who lived across the country. He disagreed and said he would be on the next flight out. Mr. Johnson was then intubated and placed on ventilator support.

I have been that doctor in numerous cases, and who can blame loved ones to err on the side of caution? They don't want the notion that they gave up too soon to be on their conscious. And so what ensues is unnecessary and unwanted intrusion into an inevitable process. The solution to this problem is simple, but it forces us to communicate our wishes with loved ones and create an official document called an "advance directive."

Creating an Advance Directive

Basically, an advance directive is a standardized document that allows people to specify their wishes for care if they are alive, but unable to make decisions for themselves. It guides loved ones and medical caregivers to be all on the same page without any questions. Advance directives specify:

  • Do you wish to be put on a ventilator machine if your breathing would require this to remain alive?
  • If your heart should stop, do you want doctors to work toward restarting this with a defibrillator or medication?
  • If you cannot feed yourself, do you want a tube to be placed to give you nutrition?

There are other more minor aspects that are also covered. Though each state has their own form, they are all quite similar. While a lawyer can help, people can absolutely complete these on their own for free.

Your doctor can provide the questions that come up during completion of the form. Take it from me - your doctor will be pleased that you have taken this step toward communicating your wishes and help you in any way he/she can. Forms can be found at most post offices and libraries. Free websites exist that provide the form and provide answers to frequently asked questions. A Google search under "advance directive" will provide several.

To complete the form, a signature is required along with those of witnesses. Once completed,  the document and your wishes should be communicated to all those in your doctor and immediate circle that may be involved in medical decision making in the event that you are unable.

The Medical Power of Attorney

Of course, this advance directive cannot provide for every contingency that may come along. In this case, it's wise to name someone as your designated medical decision-maker. This person should be someone who has your best interest in mind and knows you well. I remind medical power of attorneys that their job is to decide as their loved one would decide in the situation.

To officially chose a medical power of attorney, a form is required. These forms can be found right along side the advance directive forms.

Who Should Get an Advance Directive?

  • You: Who wouldn't want their wishes to be carried out in a desperate medical situation? Even if you are young and healthy, understand that tragedy can strike anyone, anytime, and in the blink of an eye. Further, it is the responsible thing to do for loved ones who may be forced to "guess" your wishes in such a situation.
  • Your Loved Ones: Communicate the need to "get things down officially" to those who may be called upon to make decisions. Not only will it serve them, but also you if the situation should arise.
  • Americans: Our country is in a crisis. As we look to make healthcare affordable we must look to the fact that the majority of healthcare cost in a life span occurs in the last six months of life. Much of this care is simply unwanted due to the lack in communication. Advance directives can solve this problem, providing care only where it is desired. This will, in turn, save countless healthcare dollars.

In Conclusion...

The notion of death is uncomfortable for most of us. The fact of the matter, however, is that it is inevitable. In this day and age, the process can be complicated by decisions about different levels of care. Advance directive and medical power of attorney designation can make this situation more comfortable for everyone involved.

Photo Credit: JuanChristophe

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1 Comment

  • Great subject Dr. V! I have a filled out advance directive despite only being in my 30s. Last thing I want is my wife, mother, or children fighting over what happens to me. Or worse, making any of them make that decision.

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