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Advance directives help patients spell out healthcare decisions

With a third holiday season underway amidst a global pandemic, some individuals are setting aside time during family gatherings to have difficult healthcare discussions and presenting their loved ones with signed copies of their Directive to Physicians, Family or Surrogates (Living Will) and Medical Power of Attorney. Also known as advance directives, the documents can remove the burden from family members who may be called upon to make critical decisions should a loved one fall ill.

Pandemic showed importance of family discussions, Parkland experts say

“During the first, second and even third surge of COVID-19, it brought to light the importance of outlining what my wishes are,” said Claudia Hayes, 74, of Midlothian. “And it goes beyond just the coronavirus. What if I’m in a car crash? What if I am diagnosed with some other life-threatening disease? What better time than now to make sure difficult healthcare decisions don’t fall on my family?”

Advance directives are legal documents that allow you to spell out your decisions about end-of-life care or indicate whom you want to make these decisions if you are unable. By planning ahead, you can get the medical care you want, avoid unnecessary suffering and relieve caregivers of decision-making burdens during moments of crisis or grief. You also can reduce confusion or disagreement about the choices you would want people to make on your behalf, according to Krister White, M. Div., ACPE Certified Educator and Director of Spiritual Care at Parkland Health.

Advance directives aren’t just for older adults. Unexpected end-of-life situations can happen at any age, so all adults over the age of 18 need to prepare the documents. In addition, copies should be given to your family and your healthcare provider.

There are four types of advance directives: a Directive to Physicians, Family or Surrogates (Living Will), Medical Power of Attorney, Declaration for Mental Health Treatment and Out-of-Hospital Do-Not-Resuscitate (OOH DNR).

A medical or healthcare power of attorney is a type of advance directive in which you name a person to make decisions for you when you are unable to do so. In some states, this directive may also be called a durable power of attorney for healthcare or a healthcare proxy. The person you name may be a spouse, another family member, a friend or a faith community member. You may also choose one or more alternates in case the person you chose is unable to fulfill their role.

A directive to physicians is a written legal document that spells out medical treatments you would and would not want to be used to keep you alive, as well as other decisions such as pain management or organ donation.

“In determining your wishes, think about your values, such as the importance to you of being independent and self-sufficient, and what you feel would make your life not worth living,” White said. “The questions you should ask yourself are, ‘Would I want treatment to extend life in any situation and would I want treatment only if a cure is possible?’ These are tough questions to ask yourself, but it’s better than leaving family members to try to figure out what you may have wanted, especially if you’ve never discussed it.”

Another directive to consider is the Out-of-Hospital Do-Not-Resuscitate. The OOH DNR order is a form signed by the patient or proxy and their physician stating they do not want any life-sustaining treatments in the hospital or doctor’s office, at home or in an emergency vehicle.

“No one expects or plans to end up hospitalized in a trauma center. Things can happen quickly and unexpectedly, and they can happen to anyone, even young people. Patients with severe injuries may need to be quickly placed on a ventilator and are sometimes very sedated, making it difficult for them to clearly communicate with hospital staff or participate in decisions regarding their care,” said Courtney Edwards, DNP, MPH, RN, CCRN, CEN, TCRN, NEA-BC, Director of Trauma Community Outreach for the Rees-Jones Trauma Center at Parkland.

“Advance directives help the medical team understand the patient’s wishes and they also provide support to family members as they work with the medical team. Families are often burdened with decisions about invasive, but potentially life-saving treatments and they have to ask themselves what their loved one would want,” Edwards said. “I’ve seen how difficult these questions can be for families in the trauma center, especially when the patient is older or had other health problems before the injury. Advance directives can remove some of this uncertainty and at least partly relieve the stress of decision-making for family members during a very upsetting time.”

“These discussions are not easy to have, but end-of-life decisions are not something we wanted our sons to have to make, so we’re making them ourselves,” Hayes said. “Even though I didn’t have this discussion with my mother, I was lucky. One day, years before she passed away, I opened the mail and found signed copies of her advance directives. When it came time to make those decisions, I didn’t have to, because she already had.”


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