This post is a topic that many are not comfortable discussing. However, I urge you to take time to consider the conversation everyone must have before it is too late.
If you are injured in an accident or suddenly become unable to speak for yourself, do you know who would be able to speak for your health care needs? Have you considered the types of treatment you would want? Do you know what type of healthcare decisions a loved one would want if they are unable to speak?
Advance Care Planning is making decisions about the type of healthcare you want for yourself before an event occurs. Younger adults often feel Advanced Care Planning is for someone who is elderly or diagnosed with a terminal condition. Not surprisingly, a majority of Americans do not have conversations in regards to what type of medical treatments they would want if they are faced with a life limiting illness.
As a palliative care social worker, I reguarly meet with families forced to make tough decisions for a loved one without any guidance because conversations were never had. This past Sunday was National Health Care Decisions Day and today I wanted to share information that everyone needs to have before an event such as car accident, fight or illness occurs.
First and foremost (with the exception of someone who is terminally ill and has completed a form) recognize that emergency personnel must always do what is necessary to stabilize someone for transfer to a hospital. Advance Directives are put into place after a physician has assessed a patient’s condition.
Advanced directives, which often include Living Wills, are legal and valid throughout the United States but laws do vary from state as well as language. You can download a copy of your state’s Advance Directive form here. Additionally, an advanced directive/living will does not need to be completed by an attorney.
A living will allows an individual to name a health care surrogate to make decisions. Without this noted, there is a legal process of who has the right to make decisions. Within the state of Kentucky, there is a legal chain that must be followed. If one is married, the spouse is the automatic decision maker. If there is no spouse, it falls to biological children, followed by parents, siblings and down the biological line.
Sadly, a couple who is living together but not married can not make healthcare decisions for each other without a living will. Additionally, if a couple is separated and divorcing but still married, the spouse is still the decision maker. If you are divorcing someone, do you want them to make decisions about your health care? Many name an alternate health care surrogate in case the first is not available. This can be helpful in case a couple is in an accident at the same time.
Following the naming of a health care surrogate, one can make note of specfic treatments and considerations that meet your personal values, concerns, spiritual beliefs and views.
Here are a few questions you may want to explore.
- What aspects of life give it the most meaning?
- How do your religious or spiritual beliefs impact your view of dying?
- What is your view of death?
Decisions that health care surrogates often must make include:
- The use of artificial ventilation. A patient can typically be on a ventilator for no longer that 14 days before a decision must be made to have a permanent tracheotomy. This is a surgical procedure and it is possible to be reversed.
- The use of artificial nutrition, fluids and antibiotics. It is important to consider if one would want a permanent feeding tube.
- Aggressive treatment in the way of dialysis, possible amputation of limbs to save your life.
An advanced directive may have space for you to mark:
- That you want to extend your life as long as possible with whatever means.
- Allow a natural death to occur if physicians feel there is no cure.
- The level of use of machines and medication.
- They type and level of resuscitation if the heart stops.
- Organ donation
Although these decisions and discussions can be difficult, by having them early, loved ones have a better understanding of what is wanted. Please take time to review your state’s advance directive and utilize it as a place to begin having conversations. For more information on Advance Care Planning, visit The National Hospice and Palliative Care Organization.
Have or will you be completing an advance directive? Let me know if you have questions.
Come join me for monthly articles that help you stop existing and start living! First newsletter appearing in May!