Let’s talk about what happens if you experience a health crisis, are unable to make decisions for yourself, and do not have advance care directives in place. Without guidance from a Living Will, or your designated Health Care Power of Attorney, a DNR (Do Not Resuscitate Order) and/or POLST (Physicians Orders for Life Sustaining Treatment), medical personnel use all available measures to keep you alive. As soon as possible they turn to your next of kin for guidance, your spouse, parents, or adult children. All these steps might be fine with you. However, how would you feel if you were separated from your spouse, yet he or she is your next of kin and the only person available? What if you prefer to have a partner or friend make health care decisions for you rather than a parent or adult child? The person you want to make decisions for you may not be able to do so unless there is a health care directive in place. It’s easy to see how in an emergency, when decisions must be made quickly, someone, even a stranger, could end up having to make a choice about your treatment—and the choice might be one you really did not want. Furthermore, if you have no family it is possible that a guardian could end up being be appointed to make decisions on your behalf.
To be clear, as long as you are able to make health care decisions for yourself you get to do that. Advance care documents, and the choices you make in them only become active when you are unable to make decisions for yourself, for example, if you were unconscious or in a coma due to an accident, or in shock or delirious as a result of some other trauma, infection or fever, or had suffered a stroke or heart attack. We hear about such events all the time but rarely think it applies to us. However a health care crisis can happen to anyone.
That being said, most of us are reluctant to think about the type of care we want in the event of a future health care emergency. It’s unpleasant, scary, unsettling. It brings us face to face with our vulnerability and mortality which most of us would rather avoid. Whether or not this is the reason, a majority of people, almost 70% according to some studies, do not have advance care planning documents in place.
The practice of medicine has changed radically in the last 50 years. The ability to treat once fatal diseases, infections and other conditions has exploded along with the means to keep people alive. And the medical environment has changed. My parents often talked about a time when doctors knew their patients and their patients’ families. Theirs was a high respect, high trust relationship and they deferred decision making to their doctors. They would never have thought of questioning a medical professional, even a doctor they did not know, or a medical decision. But times have changed. As the medical care has advanced it has become more impersonal, formal and institutionalized. It is most unlikely that you will know the doctor who treats you in the emergency room, or even in the hospital. At the same time we, as consumers, are more knowledgeable and more aware of the risks. We know that medical errors occur. In addition, most of us want some control over our health care choices since those choices often have significant consequences.
Advance health care directives allow you to tell others what kind of care you want or do not want and to choose who you want making health care decisions for you if you are unable to do so for yourself. These are documents you should have in place. They should be reviewed periodically so that they always reflect your current choices. After all, decisions can change over time. If you are in your 20’s and basically healthy you might want all means used to keep you alive if you were in an accident, for instance. However, if you are in your 90’s you might feel differently, or not. So even though most of us do not like this type of planning it may be one of the most important things we do to ensure that we have the type of care and quality of life we want at a time when we are vulnerable and unable to make those choices ourselves.
The National Institute for Health (NIH) has an excellent webpage that describes each document in detail. I strongly recommend that you check these out, talk to your attorney, and make it a priority to complete your advance health care directives. Your future quality of life could depend on it.