Preparing for the Inevitable: The Importance of Advanced Directives in End-of-Life Planning
Allison DeMajistre, BSN, RN, CCRN
Healthcare Consultant, Premium Ghostwriter, and Medical Copywriter bringing information and power back to patients and caregivers
No one can plan their exact date and time of death. It may come unexpectedly or be imminent after a long illness.
I can’t count the number of times I’ve watched family members struggle with making decisions for a loved one who can no longer voice their wishes and never put anything in writing. Imagine being the one who decides whether to withdraw care, take out a breathing tube and turn off the ventilator, or stop all supportive medications and allow a natural death. I don’t have to imagine it; I’ve seen it happen, and it’s devastating for the decision-maker. I’ve heard people say they are haunted by those thoughts even years later.
While it’s impossible to control when you go, you can direct how you’d like your final days to unfold and be the final decision-maker. By talking with those closest to you about how you spend those final days and putting those thoughts into a written advanced directive, the control is in your hands. It only takes a few small steps to ensure you receive the care you want and avoid what you don’t, especially if you cannot speak for yourself.
Too many people put off making decisions about end-of-life care because thinking and talking about death is uncomfortable, but having the proper documents in place when the time comes will help guide everyone who loves you and is involved in your care. It will give them peace of mind knowing they are following your wishes, and you will have the control you deserve in your final days and hours.
It starts with assessing your core beliefs, which will continue to guide you through the planning process.
Values and Priorities
The first step is deciding what matters most to you when you see yourself in an end-of-life situation, especially if you cannot communicate what you want to others.
Here are a few things to consider:
Beliefs and values
Think about your spiritual or religious beliefs toward death and dying terminal diseases, and treatment decisions. Would you want life-sustaining treatment regardless of the circumstance, or instead want to be allowed to die naturally if there is no hope of recovery?
Quality of life
What do you consider essential for your quality of life? Think about how you would feel if you could no longer take care of yourself, couldn’t get out of bed, feed yourself, or couldn’t breathe on your own
Life-sustaining treatments
If you were diagnosed or living with a terminal condition, think about what procedures or treatments you would want or not want. Some examples would be a feeding tube for nutrition or a tracheostomy to help you breathe.
The Advanced Directive
Advanced planning starts with a signed advanced directive that makes your end-of-life preferences clear if you can’t make medical decisions for yourself. An advanced directive typically includes a living will and a durable medical power of attorney. It can also contain documents like Do Not Resuscitate (DNR) orders and advanced directive addendums.
The living will
Your decisions about life-sustaining measures are included in the living will. There are many scenarios today where modern medicine can sustain life beyond what our bodies can do alone, including breathing independently, maintaining adequate blood pressure and circulation, having functioning kidneys, or the ability to eat.
How long do you want to live once your body can no longer work for itself? What do you consider a quality life?
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Advance directive forms will normally mention two scenarios where life-sustaining treatments could intervene: terminal illness and a permanent state of unconsciousness without a chance of recovery. However, there are other events to consider like sudden cardiac arrest or a traumatic brain injury.
Withholding versus withdrawal of treatment
Choosing not to initiate a life-sustaining medical intervention is considered withholding care with the expectation that the person will die without medical therapy.
Withdrawal of treatment is when a medical therapy that has already been initiated is stopped. Often, a person or their representative will decide on a time-limited trial of life-sustaining therapy with hopes for improvement. Therapy will be stopped if the person fails to improve within that timeframe.
One thing to keep in mind is that some state laws require a signed document when you want to withhold life support and are not able to speak for yourself. If you have nothing in writing, state law will require the initiation of life support. Also, if you want life support to be withdrawn after a certain period of time, it needs to be included in the advanced directive.
The medical power of attorney
Naming a representative in your medical power of attorney (POA) gives that person the power to follow through with your medical wishes and make decisions about the healthcare you receive if you can’t do so yourself.
Choosing a representative
Your medical POA can be anyone you trust who is at least 18 years old. If your primary POA isn't available, you can also choose an alternative representative.
You should select someone who understands your wishes, values, and religious beliefs and who you trust to follow through with your living will. Ensure you thoroughly discuss all matters with the person(s) you appoint and that they understand and agree to take on the responsibility.
Family members like your spouse, brother, sister, adult children, or even a close friend are all appropriate choices. If you’ve appointed your spouse and are later divorced, the appointment is automatically revoked, and you will need to choose another representative.
The only people you can not appoint as your medical POA are:
Talking about death
One of the best ways to ensure your wishes are honored at the time of your death is to talk about them with your loved ones. The more they know and understand how you feel about death and how you envision what will happen when that time comes, the better your chance of having your vision realized.
Remember, by letting your friends and family know what you want at your death, you allow them to act in your best interest rather than wondering if they are doing what’s best for you.
You can get free Advance Directive forms from AARP.org. For more information, go to HealthInAging.org.
Health SaaS Writer & Content Strategist | Telehealth Nurse | Digital Health Expert
11 个月The more we educate on the importance of ACP, the more we empower everyone to choose what is important to them. I also just finished my own piece on this. There are so many parallels between mine and yours. I think that, as nurse writers, we are the best placed to share the importance of ACP in written communications! Have any other nurse writers written on this topic this week?
So heartbreaking indeed! I love the 5 wishes and have given it to several family members including my parents. I hope if they don’t fill it out it at least sparks conversation!
Freelance Health Writer | Registered Nurse | B2B + B2C health content | Health Professional Writer | Journalism | I provide fresh, accurate, and engaging health content to elevate your brand & reach your audience!
11 个月This is such an important conversation. My father did not appoint someone and we missed the window when he had mental capacity to sign one. It was a nightmare. My husband and I set up power of attorney, personal directive and updated our wills within a week of my retiring home. We have also openly discussed our wishes with our family. It’s one less decision they have to make!
Final Year Medical Student, With A Special Interest In Radiography || A Top Rated Medical Writer, Highly Recognized By Favikon || Eager To Learn And Grow || Email ??: {[email protected]}.
11 个月Quite insightful ? Allison DeMajistre, BSN, RN, CCRN
Nurse Freelance Writer // Content Marketing // Aspiring Journalist Mental Health // Functional Medicine // Cardio-AI // Public Health
11 个月I agree that this is so important. When offering it in the hospital, which we were required to do, so many patients confused it with having a legal/financial power of attorney and didn't understand the stipulations of the HCPOA. In the hospital setting, it's too busy for nurses to take on this role. The best place may be the primary care office? I agree-such unneeded guilt for families when it could have been spelled out for them and taken out of their hands. A great post! -reminding every one of us to get this done!