Ideally, each of us would be able to make our own health care decisions throughout our lives. But in reality, many will have at least a limited period of time when we are unable to communicate our health care choices. Advance health care directives increase the likelihood our wishes are followed, when we are not in a position to voice them.
Advance health care directives are written directions that appoint another individual to make heath care decisions when a patient is unable to effect such decisions, and frequently include patients’ specific directions on the care they want to receive. Advance directives include a power of attorney that appoints a health care agent, a living will that leaves instructions on end-of-life care, do-not resuscitate orders and values surveys that offer guidance on care decisions.
To encourage advance health care planning, April 16th is National Health Care Decisions Day. Most adults put off planning and may be confused by conflicting information and myths about advance health care planning. Let’s clear up a few common myths:
Myth No. 1: Advance directives are only for older people.
False. It is true older people are most likely to use advance directives, but every adult needs one. You never know when an accident or injury might leave you temporarily unable to communicate. Young adults should at a minimum name someone to make health care decisions when they can’t.
Myth No. 2: You have to use your state’s statutory form for advance directive to be valid.
False. Most states do not require a particular form for advance care directives, but they do have special rules on how directives should be signed to be valid. An elder law or estate planning attorney can tell you what is required in your state. The ABA Commission on Law and Aging has information on the laws in each state and links to state specific forms at http://www.americanbar.org/groups/law_aging/resources/health_care_decision_making.html.
Myth No. 3: Advance directives are legally binding, so doctors have to follow them.
False. The decision on treating or not treating is based on the doctor’s assessment of your medical condition. Doctors may ignore the instructions in an advance directive if they consider them to be medically inappropriate or they have an objection of conscience. The only reliable strategy for having your desires followed is to discuss your wishes with your providers, make sure your doctors are willing to support them, and then document your wishes.
Myth No. 4: An advance directive means “do not treat.”
False. An advance directive can describe both the treatment one wants and what one does not want. Ending life-saving or life-prolonging care is only done when there is no hope of recovery.
Myth No. 5: If I name a health care agent, I give up the right to make my own decisions.
False. As long as you have the ability to do so, you are in charge of your health care decisions.
Myth No. 6: I should wait until I am sure about what I want before signing an advance directive.
False. While you may not be ready to contemplate the end of life, you should appoint a health care agent. Your directives can easily be updated as your wishes change.
Myth No. 7: Just talking to my doctor and family about what I want is not legally effective.
False. Meaningful discussion with your doctor and family is the most important step. But the best strategy is to combine talking with documentation, and make sure all parties have a copy.
Myth No. 8: Once I give my doctor a signed copy of my directive, my task is done.
False.. You need to make sure your doctor understands and supports your wishes, and that all of your health care providers are aware of your directive and have a copy. You should also review your wishes when any of the Five Ds occur: a new Decade in age, the Death of a loved one, Divorce, a Diagnosis of a significant medical condition, or a Decline in your medical condition.
Myth No. 9: If I am living at home and my advance directive says I do not want to be resuscitated, EMS will not resuscitate me if I go into cardiac arrest.
Usually False. If you are terminally ill and do not want to be resuscitated, you should talk to your attorney and health care provider about an out-of-hospital do-not-resuscitate (DNR) order. If you create one, you should talk to your local EMS providers to see if they will honor it, and your health care providers on what to do if EMS will not honor the DNR.
Myth No. 10: You must have a living will to stop treatment near the end of life.
False. Treatment that is no longer leading to stable or improved health can be stopped without a living will, if agreed to by you, or your health care decision-maker and your doctors. However, the benefit of a living will is that it allows you to leave instructions beforehand about the health care you want, or do not want, when death is imminent.