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Make plans during Health Care Decisions Week

by Pam Eimers
October 15, 2006

Beverly Paine of Davis calls herself The Poster Child for Advance Directives. Following a class on end-of-life planning taught by Yolo Hospice RN Patty Zavala, Paine recognized the need to update her 10-year-old document. The ink was barely dry when Paine found herself being rushed to the hospital in the midst of a heart attack.

Paine’s Advance Directive was not needed but she is thankful to have a document that will speak clearly for her if the next time she’s not so fortunate.

The California Legislature has declared October 30 through November 5 as Health Care Decisions Week. We are encouraged to think about the types of care we would want if we become seriously ill or incapacitated, discuss our wishes with our loved ones and doctors, and write down this information in an Advance Directive document. If you are among the 50% of adults who have not completed an Advance Directive, Paine encourages you to get to work. “Everyone 18 and older needs an Advance Directive,” she cautions.

“Medical decision making is about what is possible,” says Scott Christensen, MD, Associate Professor of Hematology and Oncology at the UC Davis School of Medicine and Yolo Hospice Medical Director. “Advances in technology have really given us the illusion that life is unending.” Just because it’s possible, is it the right thing to do? Christensen emphasizes that decisions concerning treatment need to include discussions of appropriateness, something that is very personal.  There is no one right answer. As an example Christensen offers, “I can put you on a ventilator, but should I? What’s the goal?”

These decisions are not static. “These conversations need to take place continuously throughout life,” Christensen advises. “The definition of quality of life changes for all of us as we move through life. Our perspective changes.” 

During Health Care Decisions Week take time to think about what you want, discuss it with your family and write it down. Here are the major decisions you may contemplate.

Designate a Power of Attorney for Health Care. Also called an Agent, this person makes healthcare decisions on your behalf if you are unable to do so yourself. Choose someone who knows you well, understands your desires and will not be shy in dealing with medical personnel or outspoken family members. Let your family and physicians know who this person is and how to reach him or her.

Complete an Advance Directive.  Specify the life-prolonging treatments you do and do not want. This is a legal document that you fill out yourself. It requires the signature of a witness but not an attorney or notary. It gives your Agent and physicians guidance in making difficult healthcare decisions.

Not all Advance Directive documents are the same. Laws differ from state to state so newcomers to California need to complete a directive that conforms to this state’s laws.

Within California many forms are available, some free, others for a small fee. All contain basic choices; some include additional information and options.

The free Advance Directive packet available from Yolo Hospice includes worksheets to assist you in clarifying your decisions and facilitating family discussions. Copies may be downloaded from our website at www.yolohospice.org or call our office to receive a copy by mail, 758-5566.

Talk about organ donation. You may indicate your desire to be an organ donor on your driver’s license and in an Advance Directive. However, your family must consent to the process. Be sure your family knows whether or not you’d like to be a donor.

Consider hospice care.  This option is included in the Advance Directive provided by Yolo Hospice, but not in other versions. You may however express your desire to have hospice care in an Advance Directive from any source. We encourage people to think about the care they wish to receive if they elect to forgo aggressive treatment or prolonged life support and wish to return home to live out their lives. It’s a choice available to everyone.

If appropriate, discuss a Do Not Resuscitate (DNR) Order with your physician. Only your physician can write a DNR order, and only after thoughtful consideration of your health condition. A DNR order is most often drafted while a patient is in the hospital following a catastrophic event from which recovery is unlikely; it may also be suitable for some people in the end stages of a chronic debilitating illness who do not wish to be resuscitated by emergency personnel.

None of us can predict with certainty the medical emergencies or health crisis we may ultimately face. But with careful thought, open discussions with loved ones and proper documentation we can guide our families and physicians in treating us in accordance with our wishes. As Paine attests, that provides great peace of mind.

Yolo Hospice offers community education programs on end-of-life issues and Advance Directives. For information call 758-5566.

 

 

 

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Quotes

Judy Norton
"Coping with terminal illness is all consuming for patient and family. As a hospice nurse, I feel it is most important to advocate, respect and use the knowledge we have to make the end of life the most comfortable it can be while always keeping in mind the unique needs of each patient."
~Jody Norton, RN