Using Advance Directives to Plan for Life's 'What-ifs'

You’ve probably been told to ‘live your life’ and ‘be in the moment,’ so it’s no surprise that you might not want to think about the what-ifs. What if you are in an accident or become too sick to make decisions about your own healthcare? Will your family know what you want -- or don’t want -- done to keep you alive?

Taking time to think about your what-ifs will not only save your family the stress from making difficult decisions, but it will provide emergency care personnel a plan for how to treat you.

“Advanced directives are legal documents that allow patients to state their wishes regarding their end-of-life care, no matter what their age,” explains Robin Malik, MD, Family Medicine doctor with Roper St. Francis Physician Partners Primary Care.

These documents can include a living will, power of attorney for healthcare decisions, and Do Not Resuscitate (DNR) orders.

According to a 2017 study from the Palliative and Advanced Illness Research Center, the number of Americans who have actually created advance care planning documents remains low. They reviewed 150 studies that surveyed 795,909 Americans and only 36.7 percent had completed some form of advance directive. Only 29.3 percent had completed a living will that contains actual care wishes, and 33.4 percent had designated a healthcare power of attorney. Completion rates were slightly higher among patients than among healthy adults and higher among patients ages 65 and older than among younger adults.

However, calls for advance directives have increased in some areas, thanks to the impact of Covid-19. For example, in a West Virginia Center for End-of-Life Care, the center distributed more advance directives in the first six months of 2020 than it had during the same months in the last five years.

Your advance directives can be as detailed or as simple as you want them to be. “You can spell out exactly what you would or would not want in a living will, including any number of things, such as how aggressive you want to be in treatment, if you want feeding tubes or any kind of pain management, ventilators and other life support,” said Dr. Malik.

Consider what kind of quality of life you would like should something happen to you. For example, what if you were paralyzed or in a coma on a ventilator, what would you want the doctors to do?

“Or if you don’t want to do that, you can just name your healthcare power of attorney, so that is the person who makes the decisions,” said Dr. Malik. “If you do not name someone to make these decisions, they will fall to your spouse or adult children first if necessary.”

A Do Not Resuscitate or DNR order means that if you stop breathing or your heart stops, nothing will be done to try to keep you alive.

“But if the patient is awake, alert and able to make their own decisions, then that overrides any of this documentation,'' said Dr. Malik. “So, if you were to fill out an advanced directive and then change your mind, know that it will be honored.

Dr. Malik stresses that it’s better to make these decisions when you’re healthy and able to do so. Keep in mind that decisions you make when you’re younger may also change as you get older. As you age you may be diagnosed with certain medical conditions that can also change the wishes for your advance directives, so be sure to revisit them throughout the years.

“Talk to your healthcare provider about the paperwork you need to do,” she said. “We are unfortunately encountering a lot of younger folks that have never talked about this with their families and, because of the pandemic, are having to make decisions without knowing what their wishes are. So, it’s also important to talk to your family too.”

For more information on Advance Directive’s from Roper St. Francis Healthcare, go to: https://www.rsfh.com/advance-directives/