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Advance directives lift burden of tough decisions at end of life

Advance directives allow individuals to determine what medical interventions they do and do not want, and also appoint decision makers to make choices on their behalves in the case they become incapacitated.

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By
Natalie Yerger
, freelance reporter
This article was written for our sponsor, 3HC.

A woman was clear about her wishes before she had a stroke — in the case of a serious medical event, she did not want a feeding tube. She had even expressed her wishes in an advance directive years before her stroke.

"Her family panicked and put a feeding tube in [anyway]," said Dr. Taylor Goodnough, a specialist at a hospice care center, recalling her former patient's situation.

The intervention prolonged the woman's life for several years. Not long after her death, the unlocated advance directive was found.

"The family came back years later and said, 'We hate that we've done this. We're not sleeping at night with the fact that we've not done what she wanted,'" Goodnough recalled.

Without knowledge of an individual's end-of-life desires, it's hard to honor them. This is why documentation like advance directives are important.

What is an advance directive?

"Advance directive is a broad term that can encompass several different legal documents but primarily includes a Living Will and a Health Care Power of Attorney," explained Mark Hale, an estate planning attorney in Goldsboro.

These documents allow individuals to determine what medical interventions they do and do not want, and also appoint decision makers to make choices on their behalves in the case they become incapacitated.

Cases like the unnamed woman's highlight the importance of this type of documentation; while her advance directive was simply misplaced, many individuals lack them entirely. Hale said these documents address non-financial, end-of-life issues that are extremely important for families.

"The vast majority of my clients tell me that they would not want to have life-prolonging measures implemented at the end of life. Without advance directives, the decision to remove life-prolonging measures can be very difficult for a spouse or child," Hale explained.

The burdens families may face without such documentation are not just emotional, either.

For example, if no surrogate decision maker is named, families may disagree, resulting in a deadlock that only the court system can break. The outcome can be an expensive, public proceeding that may not result in what the patient wanted in the first place.

"Having advance directives in place has often been referred to as a 'gift' to your family," opined Hale.

While advanced aging is a natural motivation for considering end-of-life decisions, anyone 18 years or older can benefit from preparing these documents.

"There is no age too young to consider advance directives," Hale said. "This is because nobody knows when an illness or accident may occur, and the directives may need to be utilized with no advance notice."

The document can be amended at any point in time and should be reassessed throughout one's life.

"When you get married is a good time to start discussing this. When you get divorced, it's a good time to reassess the situation because you might have had your spouse as the person to make those decisions, and you might want to change that," Goodnough said.

Guidelines for preparing an advance directive

While it may seem fair to appoint multiple children as healthcare directors, Goodnough recommended one decision maker to avoid prolonged standstills. She also recommended keeping documents in an accessible place.

Health care agents, doctors and loved ones should be provided with copies, and the originals should remain in an obvious spot rather than in a safe.

"With my patient population in geriatric centers, they put it on their refrigerator," Goodnough suggested.

While these documents don't need to be prepared by an attorney, Hale recommended using one to ensure they accurately reflect your decisions and abide by state-specific requirements.

Perhaps the most important step in preparing an advance directive, however, is for individuals to have conversations with those who will help manage their care. Communicating end-of-life wishes in person will increase the likelihood that preferences are abided by in the long-run.

"I think it's an absolute necessity in empowering people to make those decisions ahead of time. It's difficult," Goodnough sympathized. "No one wants to think about that, but a lot of people know for sure they don't ever want to live on life support."

This article was written for our sponsor, 3HC.

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