If You Don’t Have an Advance Directive, Now is the Time to Create One

From Chad Marks, Director of Palliative Care at Lee Health 

Life is unpredictable. Though we don’t like thinking about it, accidents or illnesses can happen at any time to anyone, at any age. Because of this uncertainty, it is important to consider and document your wishes regarding medical treatment in the event you are ever incapacitated, or unable to speak and advocate for yourself.

The month of April is a time to make sure you have a plan, if you don’t already. With the designated National Healthcare Decisions Day taking place over the weekend, this time of year is meant to remind and empower people to create a plan.

The plan is the creation of an advance directive, and an advance directive includes two parts: a living will and the designation of a health care surrogate. A living will contains instructions about whether you want life-prolonging procedures in the event you have a terminal condition, an end-stage condition or are in a persistent vegetative state.

It’s important to note that the health care team does not look at someone’s living will unless they meet the criteria to do so and are unable to make their own decisions and cannot communicate with the health care team. Additionally, the living will does not address your code status – whether you want to be resuscitated or not. The do not resuscitate form, commonly called a DNR, comes from discussions with your doctor or medical team. The DNR must be signed by both you and your doctor and should be uploaded to your electronic health record.

Creating a living will helps alleviate future emotional burdens by making sure your wishes are known and followed. You want to be prepared so your family is not in a position to determine what they should do and whether their wishes align with yours.

Advance care planning is much more than simply signing paperwork; rather, it should involve serious conversation and discussion with the most important people in your life. Some tips to help you through conversations a lot of people may find difficult include:

• Pick a time when everyone is relaxed to make it easier to listen to one another.
• Encourage loved ones to speak about preferences, and do not give up if they seem resistant.
• Before committing to anything, wholeheartedly evaluate motivation, availability and skills.
• Identify contributions that can be made comfortably and plan to assist or meet anticipated needs.
• Acknowledge limits to alleviate stress and uncertainty.
• Remember, solutions require collaborative efforts to provide the most quality of life and the most cost-effective care.

I recommend that all adults 18 years of age and older have an advance directive.

In the state of Florida, it is especially important to have an advance directive because if you don't and you are incapacitated, state statute designates a health care proxy, which can be a guardian, a spouse, an adult child, an adult sibling, an adult relative, a close friend or a social worker. These people may or may not know your wishes, so an advance directive ensures that health care professionals follow your wishes without question.

You do not need a lawyer to make your wishes known or to complete these documents. Free forms and information are available for every state at www.nhdd.org or through our health system – go to www.LeeHealth.org and search ‘advance directives.’ Also, anyone with Lee Health’s MyChart can access their advanced care planning under the main menu to get further information and complete them online.

By engaging in these important conversations and addressing any issues in advance, you and your loved ones know each other’s wishes and can ensure they are met, which provides peace of mind for everyone.