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Advance Directives 

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I knew little about advance directives as I drove to a public presentation on the topic at Benedictine Hospital in Kingston a few months back. I recalled my parents mentioning forms they had filled out, suggesting I do the same. Something about putting in writing the medical procedures I would want, and not want, if I had a health crisis. But I hadn’t taken any tangible steps to do so, nor spent more than a few minutes envisioning medical details I might face “one day.”

Thanks to that superb presentation, I have done a 180-degree turnaround regarding advance directives, from a noncommittal “I guess I should” to an exigent “This is one of the most important things anyone can do! Tell everybody!” Hopefully, by the time you’ve finished reading, you will feel the same—and take action.

 

The unwanted scenario

A near-drowning, a car crash, or a sudden heart attack are situations where jump-starting a life makes sense. And medical interventions that sustain life, such as artificial nourishment and a ventilator, can avert death during a critical recovery period. Most of us are blessed to have access to the latest life-saving or life-sustaining interventions. But we’ve seen in the headlines how this can go awry. A patient slips into a coma that lasts for months or years, and continues to register brain activity but cannot sustain any other mortal function without assistance. A battle ensues over continuing or ending life support, rending family ties and turning a patient’s fate over to lawyers, judges, and, perhaps, the president of the United States.

A different scenario happens far more often: An elderly person or someone in late stages of a terminal illness has a crisis. Perhaps an elder, with a heart that is still keeping her going—but barely—passes out at home for the third time that year. Loved ones call 911 and she is rushed to the hospital. Standard medical interventions are set into motion to revive and sustain her as soon as the ambulance arrives and are continued at the hospital, no matter the physical, emotional, spiritual, (and financial) implications.

Medical care providers must do so these things unless specifically refused by a patient who is conscious and deemed of sound mind—or unless a legal document states that the patient wishes to decline certain medical interventions. Indeed, a hospital and medical staff risk being sued if they don’t try everything.

 

Opportunity of a lifetime

“We all have a terminal event,” says Kristin Swanson with gentle humor, meaning death. An organizer of the advance directives event at Benedictine Hospital, Swanson’s many years with Hospice Inc. give her a perspective many of us don’t have. She helps people plan the transition from life to death, instead of going in a powerless tangle of medical equipment and fear. “How your dying experience will go is up to you. But being in the middle of a life-altering illness is not the time to make the decisions.” And what if you’re not on death’s door, but the victim of a sudden accident and arrive unconscious, unable to participate in medical-care decisions?

This is where advance directives come in. They are legal documents that communicate your wishes when you cannot indicate them yourself. Medical advance directives are those that have medical or end-of-life implications (in contrast to certain “power of attorney” documents applicable to nonmedical matters). Three medical advance directives you should know are the DNR (do not resuscitate) order, the health care proxy, and the living will. Terminology for these can vary from state to state, somewhat complicating matters.

Each document has a different purpose. Once you have filled out the ones you wish to complete, distribute copies to your doctor and a handful of loved ones. They won’t do any good stashed secretly away. There is even an Internet service, the Living Will Registry, which provides online access to your documents by medical personnel.

 

 

Do not resuscitate order

The simplest advance directive, a DNR order, states your desire not to have cardiopulmonary resuscitation (CPR). Why would you decline these efforts to get your heart or breathing going? When a terminal illness is ever worsening, or you are near death, you may wish heart or respiratory failure to escort you across the life-to-death threshold. Note that you will need two DNR order forms, one for hospital care and one for EMTs. An EMT’s fundamental goal is to deliver a living human to the emergency room, so they will initiate CPR and other life-saving strategies.

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