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Posted: September 30, 2008

Deciding in Advance

What Are Advance Directives and Why Do You Need Them?

Theodora Powell was 87 when she tripped and fell down the basement steps of her Florence, Kentucky, home. Her daughter Jeanne found her lying on the floor several hours later and called 911. Theodora was rushed to the hospital, where her five grown children gathered to hear news of her condition.

The news was grim. Theodora had bleeding on her brain. The only way to relieve the pressure on the brain was surgery, but due to her age, high blood pressure, and other health problems, Theodora could not survive the surgery.

Without surgery, she would almost certainly not recover. In fact, she would likely die in a few days, but it would be a peaceful death because she was not in any pain. The doctors explained that they could insert a feeding tube to keep Theodora alive a little longer, but it would just prolong the inevitable.

Jeanne and her sister Carla wanted to just let nature take its course. They were certain that Mom would not want to be kept alive in this state, incontinent, unaware of what was going on around her. But Theodora’s other children wanted the doctors to do everything possible for their mother.

As a result, and because Theodora had never talked about what she would want done in this sort of situation, her children could not come to an agreement. And so a feeding tube was inserted.

A very important but usually very simple document called an advance directive would have made this situation go much more smoothly for Theodora and her family.

What Is an Advance Directive?

An advance directive is a signed statement that allows you to specify your wishes in advance of a health crisis, in case there comes a time when you are not able to speak for yourself. There are several types of advance directives. You can have one or all of them:

How Advance Directives Can Help

Having an advance directive allows your loved ones to make their wishes known – and recorded. They are able to direct the course of their care in advance. Had Theodora made out an advance directive, her children and her doctor would have known what she would have wanted done in her situation. A Living Will would have specified whether she wanted life-sustaining treatment, including artificial nutrition, under these conditions.

Advance directives can also spare loved ones from anguishing while making difficult decisions about treatment of a loved one during stressful times. It can eliminate some disagreement, such as occurred among Theodora’s children. A Durable Power of Attorney for Health Care would have designated someone to make health care decisions for her when she was unable to make them for herself.

Talking About Advance Directives

Spelling out what should or should not be done in the most dire medical circumstances is a sensitive topic, at the very least, and we are often hesitant to bring it up. We don’t like to think about what will happen when Mom and Dad are no longer able to care for themselves, and we are sure they don’t want to think about it either. But the truth is, they almost surely have thought about it and worried about it. Talking about it can be a relief.

Let them know you read an article about advance directives and want to know what they would want done if they were unable to make decisions for themselves. Listen carefully to their preferences. Then suggest they put it in writing – and sign and date it.

Mom and Dad may have some concerns about advance directives. They may worry that giving someone Power of Attorney will allow that person to control their money. It won’t automatically; the Power of Attorney only goes into effect if they are no longer able to make decisions for themselves. They can talk to an elder law attorney to get all of their questions answered.

While you’re talking about directives, it can be a good time to talk about other wishes as well. Advance directives don’t cover matters like whether Mom or Dad would want to be cared for at home or in a nursing home, what they would like done with their possessions, or what kind of funeral service they would like to have. These are things they might like to talk about, though.

Preparing Advance Directives

Advance directives must be prepared while a person is mentally competent. Don’t wait until Dad is diagnosed with Alzheimer’s disease to broach the subject. Talk about it while Mom and Dad are healthy; don’t wait until it’s too late.

Advance directives are legal documents. It’s not enough to just talk about them. You need the paperwork. That eliminates any room for disagreement. And in some cases, doctors feel they must do everything medically possible for a patient unless there is a Living Will stating otherwise.

You can have a lawyer draw up the papers for you. It should cost around $200 or $300. You can also find forms online, which you can download for free, fill out yourself, and get notarized. The do-it-yourself forms will be perfectly legal once notarized.

Mom and Dad’s doctors should all have copies of their advance directives. Each time they are admitted to the hospital, they should take a copy with them. Family members should have copies, as well.

Anyone over the age of 18 can write an advance directive, and while often only the elderly or the terminally ill have them, experts say everyone should. You never know when an accident or sudden illness will occur. So, while you’re helping Mom or Dad with theirs, take the time to do your own, as well.

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Kelly Morris is a former social worker and home health and hospice worker whose writing has appeared in a number of health-related journals. She lives in Mansfield, Ohio, and can be reached at multihearts@hotmail.com.

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