Posted: 4/10/2019
Advance directives help patients spell out healthcare decisions
Speaking with your loved ones about end-of-life care and wishes may not be easy, but Parkland Health & Hospital System providers say it’s a necessary conversation. April 16 is National Healthcare Decisions Day, and during this observance patients are encouraged to consider preparing advance directives in case a medical emergency arises.
Advance directives are legal documents that allow patients to spell out decisions about end-of-life care or indicate who they want to make these decisions for them. By planning ahead, patients can obtain the medical care they want, avoid unnecessary suffering and relieve caregivers and family members of decision-making burdens during moments of crisis or grief.
“We believe that the place for this to begin is with loved ones at the kitchen table—not in the intensive care unit, before it’s too late,” said Linda Wilkerson, Parkland’s Director of Pastoral Care. “In determining your wishes, think about your values, such as the importance to you of being independent and self-sufficient, and what you feel would make your life not worth living.”
Unexpected end-of-life situations can happen at any age, so it’s important for adults over the age of 18 to prepare the documents. After preparing these documents, it is recommended that copies are given to chosen family members and your healthcare provider.
“These types of conversations are not easy to have, but they are critically important,” said Jorie Klein, Senior Director of the Rees-Jones Trauma Center at Parkland. “The questions you should ask yourself are, ‘Would I want treatment to extend life when my body is failing?’ This is a tough question to ask yourself, but it’s better to discuss this with family members so that everyone understands how you feel about these issues rather than to leave family members with these very difficult decisions during a time of crisis. In most of these difficult situations the family will ask one another ‘what would they have wanted?’ especially if you’ve never discussed it.”
There are four types of advance directives including a Directive to Physicians, Family or Surrogates (Living Will), Medical Power of Attorney, Declaration for Mental Health Treatment and Out-of-hospital Do Not Resuscitate (OOH DNR).
A directive to physicians is a written, legal document that spells out medical treatments you would and would not want to be used to keep you alive, as well as other decisions such as pain management or organ donation.
A medical or healthcare power of attorney is a type of advance directive in which you name a person to make decisions for you when you are unable to do so. In some states this directive may also be called a durable power of attorney for healthcare or a healthcare proxy. The person you name may be a spouse, other family member, friend or member of a faith community. You may also choose one or more alternates in case the person you chose is unable to fulfill his or her role.
A declaration for mental health treatment is a document that allows you to make decisions in advance about mental health treatment and specifically three types of mental health treatment: psychoactive medication, convulsive therapy and emergency mental health treatment. The instructions you include will be followed only if a court believes that your capacity to make mental health treatment decisions is seriously impaired. Otherwise, you will be considered able to give or withhold consent for the treatments.
Another form to consider is the Out-of-Hospital Do Not Resuscitate. The OOH DNR is a form signed by the patient or proxy and their physician stating you do not want any life-sustaining treatments in the hospital or doctor’s office, at home or in an emergency vehicle.
“No one can predict the future but if we prepare first responders, emergency department staff and even our friends and family with information about our wishes for end-of-life care, then we’ve done a great service for everyone, including ourselves,” Klein added. “It’s the kind, sensible and compassionate thing to do.”
For more information on Parkland services, please visit www.parklandhospital.com.