The purpose of advance directives is so that you are making it your right to make decisions about your own medical care. This phrase applies to a wide range of instructions that one might make orally or written about actions that one would or would not want to be taken if one were somehow incapacitated and unable to join in making decisions (Corr et al, 2009). An advance directive is a topic that resonates strongly in my heart. Less than two weeks ago my husband and I had a family crisis and had to make some really difficult healthcare decisions regarding our family member. These decisions were less difficult for us because our loved one had previously given us power-of-attorney. So we knew her wishes prior to her illness and were able to make the correct decisions as a family. Unfortunately, most families don’t realize the importance of this legal document until an emergency occurs.
Authors of _Death & Dying, Life & Living_ identify six goals of death education. It is the third goal that will be the focus of my paper. According to Corr et al the third goal of death education is to prepare individuals for their public roles as citizens. In this way, death education helps to clarify important social issues that face society and its representatives, such as advance directives in health care (Corr et al, 2009). We each have the right and responsibility to make healthcare decisions for ourselves. There may be a time, whether from accident or illness, when you are no longer able to make important and necessary medical decisions. This is an opportunity for you to express your wishes and direct your healthcare decisions in advance before they may be needed.
We’re living in an age of medical miracles. Tiny babies born months too early can often be saved. Hearts, lungs kidneys and lives can all e transplanted. There are life support machines and devices for almost every purpose. Ventilators to help people breath, cardiac assist devices to take over for the heart, feeding tubes to nourish patients who can’t eat, and dialysis to support people with failing kidneys. My husband and I know this all too well with the recent diagnosis of his mother.
Medical advances have saved many lives. But with these advances have come questions about using machines to prolong the natural dying process. Kentucky laws recognize the right of individual’s to make choices about their medical care. We have the right to request or refuse treatment and to ask that life prolonging treatment be stopped. We also have the right to make out an advance directive. An advance directive is a legal paper which lets an individual to state their wishes about the use of life support machines and medical treatment. It can also be used to name someone else to make medical choices for them if they become unable to speak for themselves (ccky.org, 2010; Jasper 2007).
According to David Kelly author of _Medical Care at the End of Life: A Catholic Perspective_ claims that treatment can be morally extraordinary only when the person’s death is imminent, regardless of whether the treatment is given, is to give biological life itself an absolute value that supersedes all other values.” (Kelly, 2006).The decision to make an advance directive is personal one and should only be made after careful consideration. My mother-in-law is currently on full life support and the hospital social worker told us that because she is at a Catholic hospital their philosophy there is that withholding or withdrawing treatment does not cause death, but merely allows the natural process of dying to take place. They further stated that they will not do anything to intentionally cause her death. This was an impromptu interview, but I was able to ask the social worker a few questions regarding advance directives.
HOSPITAL SOCIAL WORKER INTERVIEW:
Q: What is an advance directive?
A: Advance directive states in writing your choices about medical care or names someone to make medical choices for you if you become unable to speak for yourself. It is called an advance directive, because it is signed in advance to let your family and doctor know your wishes regarding medical treatment. Kentucky law recognizes many types of advances directives, including living wills, healthcare surrogate designations, and durable power of attorney for healthcare.
Q: Do my mother-in-law or anyone else have to have an advance directive before treatment here at this hospital? (Keep in mind it’s a catholic hospital)
A: No. You cannot be required to make any advance directives in orders to get medical treatment, and for that matter health insurance or any other reason. It s purely a matter of personal choice.
Q: Can anyone in my mother-in-law’s family make healthcare choices for her if she unable to do so and we do not have an advance directive or do you all go by the oldest child?
A: If she cannot speak for herself and there is not an advance directive, then according to the state of Kentucky laws its first the court appointed guardian; her spouse; her adult child and if there is more than one then it’s the majority of the adult children available at the time; her parents; and then the nearest living relative and if there is more than one then it’s the majority of them (unnamed social worker, 2010).
According to the state of Kentucky adults (ages 18 or older) who are mentally competent have the right to make healthcare decisions in advance. Advance directives state your choices for medical treatment, especially in regard to life-sustaining procedures. You can also use advance directives to name a healthcare agent, who is any person you choose, to make your healthcare decisions if you are unable to do so. Advance Directives only apply if you are unable to make personal medical decisions, unless you indicate you want your healthcare agent’s authority to begin when the document is signed. You cannot be refused medical care because you do not have advance directives (Jasper, 2007).
Any time you have a healthcare need; your doctor should discuss your situation with you and obtain your consent before giving you care. Patients have the right to refuse treatment or to choose among different kinds of treatment. Patients may further leave the hospital or seek treatment and opinions from other healthcare providers. Making a responsible choice does not always mean you accept your doctor’s advice, but it does mean you understand the consequences of your choice. This right to decide to say yes or no to treatment includes consenting to, or refusing treatments needed to sustain life (Shannon, 2006).
I use to believe that once you signed the back of the driver’s license then you were giving consent for hospitals to not give you the true care that you deserved. This was a myth that I always believed until I became adult. I think that it was based on those old horror movies like COMA back in the 1970s. From a recent lecture on donation I learned the real value of signing the back of the driver’s licenses and giving consent to organ donation.
Organ transplants are truly a miracle of modern medicine. Thousands of organ transplants occur in the United States each year, yet thousands of people also die each year while waiting for an organ. The generous gift of one’s organs or tissues can allow other seriously ill individuals to live. During this lecture I learned that anyone could become an organ donor and age did not mean that you can’t necessary donate. Most importantly was that signing a donor card was not going to affect my care that I received from the hospital. Patients are given the same quality care, whether or not a donor card was signed and that donation proceedings only begin after all efforts to save my life had been done and my death had been declared. Now I feel confident that signing my driver’s license will not enhance my death.
The Kentucky Cabinet for Health and Family Services’ Long-Term Care Ombudsman (LTCO), along with other national, state and community organizations, is leading an effort to highlight the importance of advance healthcare decision-making an effort that has culminated in the formal designation of April 16th as the inaugural National Healthcare Decisions Day (NHDD) (http://www.nationalhealthcaredecisionsday.org, 2010).
Despite the fact that the importance and benefits of advance directives have been proven repeatedly for many years, only a small minority of Americans have executed an advance directive, according to information on the National Healthcare Decisions Day (NHDD) website. NHDD seeks to address this issue by focusing attention on advance healthcare planning from a variety of directions simultaneously across the United States. Any number of professionals such as healthcare providers, chaplains, attorneys, and long-term care ombudsmen can provide clear, concise, and consistent information and tools for executing written advance directives about healthcare power of attorney and/or living will in accordance with state laws (http://www.nationalhealthcaredecisionsday.org, 2010).
In closing, most people can’t read your mind when you’re healthy, let alone try to figure out your wishes during a major health crisis while under additional stress. Be kind to your loved ones; make those decisions in advance; and have them legally documented.
NATIONAL HEALTHCARE DECISION DAY
DO YOU HAVE AN ADVANCE DIRECTIVE?
Do you know what healthcare treatments you would and would not want if you could not speak for yourself? Do other people know what your wishes are? The 2nd Annual National Healthcare Decision Day will be held on Friday, April 16, 2010, a day for all people regardless of age or current health to be reminded of the importance of making their healthcare wishes known to loved ones and their care providers.
Everyone is encouraged to voice their wishes and take steps to ensure that their choices are known and protected. An Advance Directive is a legal document that tells healthcare providers who it is that you wish to make medical decisions for you and what treatments you would want or not want, if you are ever not able to tell care providers what you would want in a medical emergency or life-limiting illness. The simple act of creating an Advance Directive can turn out to be an incredible gift for loved ones in the event of an accident or severe illness.
Advance Directives are written instructions about your future medical care. They do not go into effect until you are no longer able to make decisions. Adults can benefit from thinking about what their healthcare choices would be if they were unable to speak for themselves.
ADVANCE DIRECTIVES COME IN TWO MAIN FORMS:
A _”HEALTHCARE POWER OF ATTORNEY”_ (or “proxy” or “agent” or “surrogate”) documents the person you select to be your voice for your healthcare decisions if you cannot speak for yourself. Your “healthcare power of attorney” will make medical decisions based on your wishes identified in your Advance Directive. In states that recognize these documents, families and healthcare providers cannot override your living will or your agent’s decision. It is a good idea to discuss your wishes with your friends, family members, and your doctor, now, while you still can.
YOUR HEALTHCARE AGENT HAS TO MEET THE FOLLOWING REQUIREMENTS:
• Anyone over the age of 18
• Can be a family member, loved one, or close friend
• Someone who: you trust, knows you well, will advocate on your behalf, and will honor your wishes
A _”LIVING WILL”_ documents what kinds of medical treatments you would or would not want at the end of life. A living will is a type of advance directive called a healthcare treatment directive. A living will spells out the measures you do and do not wish to have taken to extend your life when you are clearly dying. You may decide whether or not you would want breathing machines, feeding tubes, oxygen, IV fluids, or medicines to be used. A living will needs to be signed in front of a witness. A witness cannot be a relative, creditors and heirs to your estate, or your doctor. It is important that a living will cover decisions about your healthcare only when you have a terminal illness. It is better to prepare a living will when you are healthy, not when you have been ill or in the hospital.
Make sure your Advance Directive reflects your wishes. If you plan on moving to another state make sure you update your Advance Directive, because it may not be valid in the state that you move to. Some states do not recognize living wills that have been drafted in other states. Your Advance Directive does not expire and can be updated as needed. It is important for your family members to know your wishes in case of an emergency. Also, you should take a copy of your Advance Directive to the hospital whenever you are admitted so that it can become a permanent part of your medical record.
Catholic Conference of Kentucky. (2010). Catholic conference of Kentucky. Retrieved from http://ccky.org/
Corr, C. A., Nabe, C.M., & Corr, D. M. (2009). Death and Dying: Life and Living (6th Ed.). Belmont, CA: Cengage Learning
Jasper, M. C. (2007). Health care directives. Dobbs Ferry, NY: Oceana
Kelly, D. F. (2006). Medical care at the end of life: A Catholic perspective. Washington, DC: Georgetown University Press
National Healthcare Decision Day. (2010). Fact Sheet retrieved November 29, 2010 from http://www.nationalhealthcaredecisionsday.org/
Shannon, J. B. (2006). Death and dying sourcebook: Basic consumer health information about end-of-life care and related perspectives and ethical issues, including end-of-life symptoms and treatments, pain management, quality-of-life concerns, the use of life support, patients’ rights and privacy issues, advance directives, physician-assisted suicide, caregiving, organ and tissue donation, autopsies, funeral arrangements, and grief ; along with statistical data, information about the leading causes of death, a glossary, and directories of support groups and other resources. Detroit, MI: Omnigraphics.