How to Express Your Healthcare Values and Views, Even When You Can’t Speak for Yourself

Newswise — Every day, I see the painful struggles of families trying to make decisions for loved ones who do not have advance directives. For those of us who were adults in the nineties, the name Terri Schiavo can elicit strong feelings. After Mrs. Schiavo suffered a cardiac arrest in 1990 and was diagnosed to be in a full vegetative state shortly after, her family members had different ideas about what Mrs. Schiavo’s wishes would have been for her care. Mrs. Schiavo had not left any written instructions, and she could not speak for herself, so for seven years, her family members’ conflicting opinions were argued in the courts. The aggressive media coverage of her tragic story created a firestorm of discussion about the importance of documenting one’s wishes concerning medical treatments. Sadly, when the news coverage ended, so did the conversation, and people’s preparation for end-of-life care diminished. While Mrs. Schiavo’s case received worldwide attention, many families in America quietly face similar situations every day. When a loved one does not have written instructions for their care—called an advance directive—and he or she is unable to speak for himself or herself, family members are left to decide what to do. By planning ahead, you can specify and receive the care you want. Creating an advance directive can eliminate conflict and confusion in families and provide relief during a time of grief and distress. An advance directive allows physicians and your family to take good care of you and respect your values and views.

The best way to realize the positive value of advance directives is through education and understanding:

- Pennsylvania recognizes two forms of advance directives: a living will and a durable power of attorney.

- A Living will is a legal document stating your wishes about treatment. You can specify your healthcare decisions about medical care, life support, organ donation and more.

- In Pennsylvania, a living will takes effect only when all three conditions are in place:

- Your physician has a copy of it.- Your physician has determined you are unable to make decisions about your medical care.- Your physician and a second physician have determined that you are in a terminal condition or in a state of permanent unconsciousness.- A durable power of attorney allows you to appoint a person you trust as your healthcare agent to make medical decisions on your behalf.- An advance directive only applies when you are unable to make decisions for yourself. If you regain the ability to make decisions, the power of attorney is no longer authorized to make medical decisions on your behalf.

Every adult should have an advance directive. Unexpected end-of-life events can happen to anyone at any time. It’s especially important for the elderly to have an advance directive completed and shared with a physician and their family before a hospitalization. For many, advance-care planning can create anxiety. But advance directives can be viewed in a positive light, because they speak to how you want to live your life at its end. Talking about end-of-life care is not easy, but resources are available to help you decide what’s important to you and help you communicate those wishes to your physician and loved ones. The Conversation Project, The Pennsylvania Department of Aging, and the National Hospice and Palliative Care Organization have great information. Most importantly, your physician can provide valuable support when you are making advance-care-planning decisions.