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April 16th, 2019

Completing Advance Directive Documents Can Bring Peace of Mind

By Dr. Thet Aung

Imagine that a life-threatening accident or illness has left you unable to tell your family or physicians what medical treatment you want, or don’t want.

Would you want to be kept alive no matter what, even if it meant being dependent on a machine to breathe or receiving food through a tube?

Would you want to be made comfortable and unencumbered by medical equipment, even if it meant you might die?

Would you want your spouse or children to have to decide?

This is a good time to have that discussion. April 16 is National Healthcare Decisions Day, which was established to raise awareness about the importance of having an advance directive, an umbrella term that refers to one or more legal documents stating your wishes in the event you are unable to speak for yourself.

The National Healthcare Decisions Day website (www.nhdd.org) can help you start a discussion with your loved ones about end-of-life care with The Conversation Starter, a downloadable brochure that leads you through the process step-by-step.

Making your end-of-life wishes known and filling out advance directives can save a lot of heartache during an already stressful time. It can also preserve family harmony in case your loved ones disagree about your care.

This happened with one of my patients, an older adult with a serious heart condition. He was nearing the end of his life, and his two children had conflicting opinions about how to proceed with his care.

One of them decided to change the advance directive document his father had prepared before he got sick. Fortunately, the patient had also filed the paperwork with our office, so we knew his wishes.

This was certainly an unusual situation. A more common scenario involves the heavy responsibility taken on by family members who have to decide whether or not to continue care for someone facing end-of-life health issues.

Another patient, an older woman who had a serious heart condition, avoided putting her family through this often traumatic dilemma. She spoke with her daughter about what she wanted at the end of her life.

When her condition got worse, her daughter knew it was time to call hospice, as per her mother’s wishes.

If the daughter had not discussed this with her mother, she would have been put in the position of deciding how to proceed, with all the conflicting emotions that would have caused.

A common advance directive document is a living will, which guides your family and medical team about what you do and do not want done if you are dying or do not expect to regain consciousness.

For example, is you were terminally ill and stopped breathing, would you want CPR (cardiopulmonary resuscitation) performed to revive you?

There is no right or wrong answer. Some people would want all available measures taken to be kept alive; others would rather be made comfortable before they die.

A more flexible option than a living will is to appoint a medical power of attorney or health care proxy.  A health care proxy is someone you choose, usually a trusted family member or friend, to speak for you if you become too ill to do so yourself.

When choosing a health care proxy, it’s important to choose someone who is committed to protecting your end-of-life wishes, who has the wherewithal to question your health care providers about your treatment and prognoses, and who will stand firm if faced with opposition from family or friends about your wishes.

Though many people automatically think of appointing their spouse, a parent, or one of their children as their proxy, it’s important to consider if that person will be impartial enough to represent your wishes in a life-or-death situation. It is also best if the person you choose is at least a generation younger than you, and is in good health.

Unlike a living will, a health care proxy can make decisions on your behalf based on the current situation, taking into consideration information provided by your health care provider.

You can find more information and the advance directive forms available state-by-state at www.nhdd.org/#welcome.

Discussing your end-of-life wishes with your loved ones and filling out the paperwork is important for you and your family, no matter your age. If you don’t do it for yourself, do it for them.

Thet Han Aung, M.D. practices Internal Medicine at WellMed at Schertz in Schertz, Texas. Dr. Aung received his Bachelor of Science in Biological Sciences from the University of Alberta, Edmonton in Alberta, Canada before completing his medical degree from the Universidad Iberoamericana School of Medicine in Santo Domingo, Dominican Republic. Dr. Aung completed his Internal Medicine residency at Good Samaritan Internal Medicine Residency Program in Cincinnati, Ohio, and also completed a fellowship in Geriatrics at UT Health in San Antonio, Texas.