Having Your Advance Directives Known

This past week a family member of mine was admitted to the Intensive Care Unit of an out of state hospital.  Being elderly and very ill, she had us all nervous for the first few days. Thankfully she improved and was discharged from the hospital, but the experience was emotional and difficult. However, because she had made her wishes known regarding her care, the family was able to face the issues of resuscitation, intubation and other invasive procedures with clarity.

Unfortunately, this is not always the case.  Discussions regarding how we want to be taken care if we become gravely ill are often avoided, leaving such decisions to be made at the last minute - often when the person themselves is unable to participate in decision making. That's why it is important for everyone to have made their "advanced directives" known.

The ethical principle of autonomy dictates that each one of us is the prime decision maker regarding our heath and health care.  As long as we have the capacity to understand the risks, benefits and alternatives of our decisions, then we are in control of our own destiny.  Advance directives are written or spoken directions to loved ones regarding the decision we would want to be made if we lost our capacity secondary to illness of any sort. In a sense, they allow us to extend our autonomy even when we have lost the ability to communicate.

Laws regarding advanced directives vary by state. In New York, the most important and basic step is to designate a "health care proxy", or medical decision maker to determine the decisions regarding your health if you should lose the ability to make such decisions (as determined by two licensed physicians). If you wish to designate the person to be your proxy, you need to have a serious conversation with him/her so that they know your wishes, and fill out a formal health care proxy form (available at www.health.state.ny.us/forms/doh-1430.pdf ).

No lawyer is needed; your signature has to be observed and confirmed by two other people of your choosing.  You can either simply designate a surrogate decision maker on the form, or you can provide more explicit written directives regarding your wishes for the whole spectrum of medical decisions-resuscitation, tube feeding, surgery, intravenous fluids, etc.

These discussions may be difficult, but not nearly as difficult as making decisions after a loved one has lost their decision making capacity and the family is facing a crisis.  I would advise that, before completing the health care proxy form, you consider making an appointment to speak with your primary care physician regarding the questions you (or any one of us) may ultimately face.  The designation of a health care proxy who has a clear understanding of how you want to be taken care may one day provide support and direction to your loved ones.