It's Never too Early to Start Your End-of-Life Planning

by John C. Wolf, DO

Question:

 My aunt's health has worsened to the point that she has recently been moved to a nursing home. The nurse asked me if my aunt had completed any advanced directives for her care. The term "advanced directives" rang a vague bell. I know these are instructions for care at the end of life, but who should we talk to about creating them?

Answer:

The natural consequence of being born is death. Most of us will have at least some advanced warning before we die from diseases such as heart disease or cancer. Some of us will die suddenly and unexpectedly. The tragedies of September 11, 2001, and the subsequent anthrax victims remind us of the frailty of human life and quickness with which death can overtake us. But, auto accidents claim many more victims each year.

Some individuals have conditions that limit or prevent clear communication of their wishes for healthcare at the end of life. In every state, you have the right to make choices about issues such as whether to have your life sustained by respirators or other artificial means. The advanced directives the nurse spoke to you about for your aunt's care deal with these problems. They are appropriate for your aunt who is in poor health today, but they are also important for all individuals of legal age.

Advanced directives allow the individual to clarify his or her wishes for health care in the event that illness or injury makes it impossible to communicate effectively. Some examples of this are the person with dementia or severe brain trauma who loses the ability to clearly reason or the person with multiple traumas to the face and arms whose injuries prevent communication. Advanced directives allow individuals to specify ahead of time the type of care they choose to receive or to select an individual to make these decisions for them.

Your aunt's doctor can offer some assistance in creating advanced directives for her, and your doctor can do the same for you. However, since creating and executing these documents is a legal process you might assume you need to see a lawyer to prepare them. Certainly my lawyer would agree with this and offer some supporting explanations as to why. On the other hand, if you discuss these matters with your family beforehand and can come to a mutual understanding, a simple document can be created that doesn't require an attorney's services.

Choices: Living Well at the End of Life contains instructions and forms that will guide you through creating legally-acceptable advanced directives. It is available online at www.ooanet.org. The booklet was created by the Ohio Hospice and Palliative Care Organization with assistance from the Ohio State Medical Association, Ohio Osteopathic Association, and Ohio Hospital Association. The forms in the booklet were prepared by the Ohio State Bar Association. In other words, it is a broadly accepted quality publication.