AHCD: The Dreaded Family Meeting

You’ve decided to take the high road and organize your Advance Health Care Directive (AHCD).  You’ve even gone over it with your doctor.  Well done!

Now comes the hard part: discussing what you want with your friends and family.

No matter how meticulous and careful you have been up until now, planning for all contingencies, considering the strengths and weaknesses of your support team, respecting the personal belief systems and traditions of your loved ones, you are bound to run into trouble somewhere along the way.  And no matter how detailed and farsighted you are, when the actual event takes place, things will come up that are not part of your directive.  Count on it.

You are going to have to speak to the family, and any friends who are part of the plan, so they are very clear about what you want.

  • It is far more likely that your wishes and requests will be honored if you have discussed them with lots of people, not just a few.  It may feel unnatural to share this kind of thing with more than just your spouse or partner, but you need to spread the word.  Really.
  • The family can help clarify aspects of your directive if they can bring up conversations or discussions you have had with them in the past – ‘I know what dad would have wanted here…remember when we talked with him about that friend of his that suffered so a few years back when he had that massive stroke?  It’s kind of like that for dad now’…that sort of thing.
  • Nothing keeps the peace better than advance preparation.  Discussions with family and friends will help prevent those awful confrontations and scenes we have all witnessed in ER’s and ICU’s: what do we do now, and who decides?  A terminally ill or badly injured loved one scares and stresses everybody.  And keep in mind that while a family member may have no legal authority to make decisions for someone incapacitated, they often feel they are morally obliged to take over or speak up.  Clear, written directions make all the difference.
After you have completed your directive, it may need to be notarized.  Here, simply follow the instructions on the form according to your state laws.  Keep the original yourself, in a place easily found, and give copies to:
  • Your chosen health care proxy – with clear directions on where to find the original.
  • Family members and loved ones.
  • Your primary care physician, hospital or health care facility.  See that a copy is placed in your medical record; be sure your doctor is supportive.
  • Anyone specifically named in the directive.
  • A copy can also be sent to your attorney, kept in a safe deposit box or with your will, trust documents  and other important papers.
Uh oh!  I’ve changed my mind!
Think of your AHCD as a process, a work in progress.  Things change – your circumstances, your opinions, your beliefs.  Do not put off organizing a directive because you may change your mind later on.  AHCD’s can be revoked, replaced, amended, re-organized.  As long as you are capable of making your own decisions, you are free to change your AHCD.  It would be best to check your state’s laws for the proper way to amend or cancel your directive, and of course, notify everyone involved so they have the latest version of the form.
When should you review or assess your AHCD?  Examine your directive every few years, or when any of the following happens:
  1. Decade: when you start a new decade in your life.
  2. Divorce: when you experience a divorce or other major family change.
  3. Diagnosis: when you are diagnosed with a serious health condition.
  4. Decline: when you experience a major decline or deterioration in your health, particularly when it reduces your ability to live on your own.
  5. Death: whenever you experience the death of a loved one.
(Special thanks to American Bar Association, Family Caregiver Alliance, the Eldercare Locator and


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