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National Healthcare Decisions Day: What are Your Wishes?

Jeff Anderson
By Jeff AndersonApril 16, 2013

April 16 is National Healthcare Decision Day (NHDD), a national health observance designed to emphasize the importance of planning for health emergencies and end-of-life care. NHDD encourages the public to make their wishes and expectations about medical care and end-of-life care known to loved ones and then to solidify these wishes in an advance directive (also known as a living will or healthcare directive).

We spoke with Nathan Kottkamp who is an attorney and chair of the NHDD Initiative and founded the observance in 2008. Kottkamp told us that he decided to get involved when, serving as a member of hospital medical ethics committees, he realized that almost every case that came before him could have been prevented with an advance directive.

The Purpose of an Advance Directive

The advance directive provides people the opportunity to state their wishes regarding very sensitive and personal decisions about medical care and their last days. Issues that can be addressed in an advance directive include:

  • Would you want to be fed and hydrated if you were in an irreversible coma?
  • During the last stages of life, would you favor aggressive pain management or an approach that allowed for more wakefulness and lucidity during this time?
  • If your heart stopped beating or you stopped breathing, would you want CPR or other lifesaving measures initiated?

These are only a few examples of the many issues that can be addressed in a healthcare directive. The essential piece of an advance directive is to choose a trusted family member or loved one who will have the authority to make medical decisions for you if necessary  This person is a called a healthcare proxy or durable power of attorney. You can share you wishes about care as many times as you like, but if you haven’t appointed a healthcare proxy with an advance directive, there is no guarantee that your wishes will be honored.

On the other hand, it is possible to appoint a healthcare proxy in an advance directive without delving into the nitty-gritty of any specific scenarios. In this case, your healthcare proxy would be entrusted to use his or her judgment of what’s in your best interest when making decisions about your care.

Completing an Advance Directive

The National Healthcare Decisions Day website has links to a number of legally binding advance directives that you can complete yourself. Different states have different laws about these directives, so it is important to make sure that you complete a directive that’s valid in the state in which you live. One popular advance directive form, known as Five Wishes,  is published by a national nonprofit called Aging with Dignity. This directive is valid in 42 U.S. States and is available in 27 languages. President of Aging with Dignity, Paul Malley told us, “A completed advance directive is a gift both to yourself and to those you love.  When your wishes are known, everyone is on the same page.  Family members are spared the guessing, second-guessing, guilt and emotional upheaval that can come when nobody knows what Mom would have wanted or not wanted.  These decisions are best made in the quiet of the living room, not in the hospital waiting room.”

Encouraging Elderly Parents to Make Their Wishes Known

Kottkamp says that he completed an advance directive at the early age of 20, and he emphasized that all adults, regardless of age or health status, should complete an advance directive. That said, it’s especially important for seniors to make their wishes known as hospitalizations and medical emergencies become more common as we age.

Kottkamp suggested that leading by example may be the best approach to encouraging older parents to complete an advance directive. If you complete an advance directive before (or at the same time as) your elderly loved one, you can help prevent the defensive reactions that some loved ones might have when you approach the issue. Emphasize for your loved one that you’re not implying that you think they won’t be around long. Say, for example, “Mom, I just completed an advance directive and I think you should too. It’s because I care about you and it’s the right thing to do.”

You can learn more about how to create an advance directive on the NHDD website.

Have you made your wishes known? Do you have tips to help persuade older loved ones to complete an advance directive? We welcome your comments below, and encourage you to share this article if you’ve found it interesting or useful.

Jeff Anderson
Jeff Anderson
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