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Could We Please Talk About Something Else?

No.

An Advance Health Care Directive (AHCD) is important.  Grown-up.  Considerate, too. Dull? certainly.  Threatening? maybe just a little.  A bit creepy?  sort of.  But indefinitely put-offable? no.   So let’s get to it.

You know how, when you and the family all get together and start telling stories, there are lots and lots of different versions of the same event?  And how we each stick to ours, insisting our version is the one?  How Aunt Mary told you a bunch of stuff she never shared with your sister?  And how your dad’s recollection of what your mom wanted is really different from the way you remember things?  Well, that’s how it is with a dying person’s last wishes.

Not to be insensitive here, but it is nearly impossible to know what a gravely ill or injured person wants – especially when we are all under the relentless pressure of a health crisis – unless it has been discussed well ahead of time.  There is nothing like the stress and uncertainty brought on by an emergency to fuel old family animosities.  We argue and fight about the best way to treat the patient when we really should be focused on the loved one we might lose, comforting each other, sharing time with each other. It really is a quality of life issue: organizing care and treatment preferences well ahead of time can make all the difference.

Here are some specifics to think about as you prepare your AHCD:

  • What medical treatments and care are okay?  What procedures or protocols scare you?  Do you need to find out more information about end-of-life options?
  • Who is going to be making the decisions for you if you cannot make them on your own?  And remember, there are financial decisions and health care decisions.  It could well be the same person, but does not have to be.  The same person handling both may not be right for you.
  • Do you want to be resuscitated if you stop breathing and/or your heart stops?  Do you understand how this could happen and what the procedures are?
  • Do you want to stay at home if you are seriously or terminally ill?  Go somewhere else?  Be hospitalized?
  • How is your care paid for?  Is your health insurance adequate?  How will loved ones manage while caring for you, or grieving and making final arrangements?
  • How much do you understand about what happens when a person dies?  Is the family prepared for all the changes that will ensue?
You will also want to go over things with your primary care physician.  Can you talk comfortably with your  doctor about this?  You really should be able to.  Keep in mind that he or she is probably going to be in charge of your care when the directive and your instructions come into play.  Your doctor can:
  • Answer any questions you have about the details of medical treatments and procedures used during emergencies and end-of-life situations.  He or she can help you weigh pro’s and con’s.  Too much of what we think we know about medical care comes from television and the movies.  We need real world help, here – ask!
  • Help you organize and phrase your AHCD so that it makes sense to medical professionals and care givers.
  • Indicate any confusing, illogical or inconsistent aspects of your requests.  Again, let your doctor help you.  Sometimes refusing one treatment means you are also indicating you do not want another similar or follow-up treatment. Are you sure about that?  Medical terminology is very specialized and specific.  And evolving and changing, too.  Make sure you are both talking about the same thing and understand the consequences.
  • Let you know if there is anything in your directive that he or she cannot honor because of moral, professional or personal considerations.
Next, what to go over with the family.
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