Why you should definitely have an ‘Advance Directive’

Alan Conn

People are concerned these days with self-improvement, desiring the best vitamins, self-help books, healthy diets, and activities; striving each day to make their life the best it can be at every age. People aren’t so ambitious about making sure they have an “Advance Directive,” which has everything to do with the quality of life.

An Advance Directive is a way for you, when you are rational, to create informed, uncoerced documentation that directs how you want care and focus to be if, as certified by a doctor, you become incapable of making or communicating decisions. An Advance Directive may be in the form of a “living will,” which contains instructions about the health care you do and do not wish to receive, or a “power of attorney,” which delegates the authority to make decisions about your healthcare to someone else. It can also be a combination of the two. An Advance Directive isn’t applicable when there is expected recovery from a health condition and an individual is alert and oriented to speak freely for him/herself.

Societies have become increasingly concerned with respecting patients’ wishes. This goes as far back as 500 B.C. with the Hippocratic Oath (“do no harm”). World War II produced the Nuremberg Code – prohibiting inhumane research and voluntary consent for participants in research. The 60’s produced the modern hospice movement, with a focus on paying close attention to patients’ wishes and comfort. The 70s, 80s, and 90s produced the historically significant medical and ethical cases of Karen Ann Quinlan, Nancy Cruzan, and Terry Schiavo. Some of you may remember tuning in to newscasts every night following the turmoil surrounding these women’s young lives.

All three of these women, for varying reasons, became in a persistent vegetative state with loved ones demanding attention to quality vs quantity of life.

Karen Quinlan’s parents pursued their legal right to be surrogate decision-makers for their daughter, bringing to the forefront the significance of “quality of life” and use of Advance Directives.

Lisa To

Nancy Cruzan’s case was the first case to go to the U.S. Supreme Court (1990). The outcome was that states can adopt a standard that with clear and convincing proof of a person’s preferences, treatments can be discontinued. The Federal government, in follow up, enacted the “Patient Self Determination Act” (PSDA) in 1991 that requires hospitals, nursing homes, hospices, and home health care programs to inform patients about their right to make Advance Directives. Nancy Cruzan’s case was responsible for the Supreme Court decision that reinforces individuals’ constitutional right to determine their final health care. The publicity from this case brought increased public awareness to giving thought to medical treatments and quality of life and the importance of Advance Directives.

Terry Schiavo’s case involved a dispute between family members and threatened to undermine the laws developed through the Quinlan and Cruzan cases.

Lessons learned from these very important historical cases:

These individuals were in their 20s and likely never expected to suffer a serious medical event. The time to do an Advance Directive is now, not later, not never.

Medical care can be unnecessarily prolonged, painful, expensive, and emotionally burdensome.

An Advance Directive is a way to avoid suffering and human and financial costs.

It’s important to understand the implications of medical treatments – the benefits as well as the burdens.

An Advance Directive, through a living will and healthcare power of attorney, provides comprehensive guidance regarding care.

If you choose to identify a healthcare power of attorney, make sure you’ve communicated your wishes to this person and you’re confident they will honor your wishes

If you are a surrogate/proxy for someone’s Advance Directive, remember….it’s not about you.

As of 2007, all 50 states have laws recognizing the use of Advance Directives.

Interested in completing an Advance Directive? Talk with an experienced attorney, your doctor, a hospital social worker, or contact a home health or hospice agency. Google “Advance Directives” to learn more. This article brought to you by the Eldercare Council of Forest-Warren Counties.

“Only you can control your future.”

— Dr. Seuss

Atty. Alan Conn, Esquire, and Lisa To, Hospice of Warren County – Executive Director, co-wrote this column.