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Advance directives puts your end-of-life wishes in writing

May 08, 2010|By MARIE GILBERT
  • Families can get assistance with advance directives forms from Jackie Rinehart and other social workers at Hospice of Washington County.
By Kevin G. Gilbert/Staff Photographer,

When it became a matter of life or death, Alan Clifton wanted to be prepared.

He had been diagnosed with advanced prostate cancer and the 60-year-old man immediately began to think about his final wishes.

No feeding tube. No life support. No nursing home.

He wanted peace of mind, his spouse of 35 years said. He wanted to die with dignity and he wanted to lessen the strain on his family.

That's why he wrote it all down in a living will.

It's been four years since her husband's death at 62, said Annetta Clifton, 64, of Hagerstown.

"But not a day goes by when I don't think how wise Alan was to draw up that document," she said. "Since then, I've done the same thing. I know, personally, the difference it can make."

Making the decision now

Putting your decisions about end-of-life care in writing - with documents known as advance directives - is one of the most important things a person can do, said Jackie Rinehart, a social worker with Hospice of Washington County.

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"It's a way of communicating with family and doctors when you no longer can speak for yourself," she said. "It spells out your wishes in advance so someone else doesn't have to make those decisions for you."

Rinehart said many people are familiar with advance directives, but for others, the first time they hear the words is at a hospital, a nursing home or home health care facility.

In the State of Maryland, she said, those documents include a living will and medical power of attorney, sometimes referred to as health care agent.

With a living will, a person can note what type of medical care they would want if they were in a coma; whether they would want life-support treatment if there is permanent and severe brain damage; and circumstances under which that person would not want to be kept alive.

Medical power of attorney is the naming of a trusted person who should be turned to as a decision-maker, if necessary.

Rinehart said some people are not comfortable being asked to follow through on those decisions, so it's important to talk to the person you want to appoint ahead of time.

"Sometimes, it's not advisable to appoint a daughter or son or spouse if they are too emotional about following your wishes," she said. "In those cases, you should turn to someone outside of the family."

Rinehart said everyone, regardless of age, should have advance directives.

"Unfortunately, we are seeing more and more younger individuals who are in accidents or becoming ill, especially terminally ill," she said. "You don't know the future. That's why it's important to have your medical preferences down on paper."

Understanding advance directives

A recent study by the Pew Research Center shows that, while Americans understand the importance of advance directives, only one-third of the population has completed instructions for late-life treatment.

"We have a long way to go in educating the population," Rinehart said. "It's not an easy conversation to have. But it's one that's necessary."

At Hospice of Washington County, Rinehart said the topic of advance directives is always discussed with patients.

"If they don't have documents or if they are unfamiliar with these documents, we can help them complete the paper work," she said.

Rinehart said many people don't realize they don't need to go to an attorney to complete their advance directives.

It can be done on your own, she said, so long as it is witnessed by two adults who are not named as medical power of attorney. State-specific information and forms are available online.

It's also important to know that these documents can be done and redone, she said, and that the one that is most current is the one that is binding.

That's why the Center for Advancing Health recommends reviewing your advance directive every three to five years, at the point of a new diagnosis, during progression of a serious illness or if you change doctors.

Before drawing up advance directives, Rinehart suggests doing some research.

"Think as much as you can about experiences with loved ones who have had serious medical situations or those who have died," she said. "If you were in the same situation, how would you want it handled?"

Caring Connections, a program of the National Hospice and Palliative Care Organization, suggests getting information on the types of life-sustaining treatments that are available and then decide the treatments you do or do not want.

In most states, you also can include special requests, such as organ donation, cremation or burial.

Finally, it's important to share your end-of-life wishes with your loved ones, Rinehart said.

"That way, you will know they are OK with your choices," she said.

"With my experiences, the family is extremely grateful to know a person's wishes are down on paper," she said. "It becomes black and white and it takes the pressure off of them."

The individual also feels good about what they've done, she said.

"Many times, people will tell me they're really glad they took the time to do this," Rinehart said. "They know they're doing the right thing."

"It's very empowering. You are deciding your life on your terms," she said.

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