Difficult Health Care Decisions Made in Advance

If something were to happen to you, do those closest to you know what your wishes are to get medical treatment, if you were unable to direct your own care? An advance health care directive (AHCD) provides thought-provoking questions to walk someone through the decisions that may have to be made.

Bernadita Roe is a nurse practitioner and the clinical manager of Washington Health’s Palliative Care Services.

Whether it’s about your own care or the wishes of others in your family regarding their care, it’s important to have these conversations. Roe says, “It is essential to have clarity about medical treatments you would or would not want, so that there isn’t any doubt or second-guessing if such a situation arises.”

The AHCD forms are easy to read and easy to follow, and can be obtained online or from your local hospital or physician. They are simple to fill out with questions to answer that help clarify what your choices would be in various situations, including undergoing special treatments, balancing quality of life with medical care options, and decisions about life support and end-of-life choices. The AHCD must be notarized or have two witnesses that know you well and can confirm your decisions.

The first and most important step is to identify a trusted person whom you believe would be the best person to talk with the medical team. This person could tell the medical team what type of medical treatment you would or would not want. Roe explains, “You should have conversations with that trusted person, whether it is a family member, close friend, lawyer or someone else you trust. You need to feel certain that trusted person knows you well and is willing to be your surrogate decision maker for health care choices when you are no longer able to do so for yourself.”

Make sure you record your choices in the AHCD and, if necessary, write down your rationale and other comments to attach to the AHCD so that everyone is clear as to what you wish. You also can indicate whether you want to allow your trusted decision-maker to have total flexibility in making medical decisions, some flexibility, or no flexibility (meaning the person has to follow your written wishes no matter what).

Once you’ve completed the AHCD, it’s important to go over your choices with all key family members or others whom you believe should know your wishes. “These conversations are essential so that those you care about understand your choices,” Roe advises. “Be sure to share copies of your AHCD with family members and others (your physician, local hospital, etc.), and place copies with your important documents, such as your will.”

It’s also important to revisit your AHCD periodically as you age over time. The medical decisions you identified 10 years ago may have changed due to life events and may need to be updated. “The periodic review is to make sure the medical care you are getting is in alignment with what your wishes are on the AHCD,” Roe adds.

Advance health care directives may be obtained online from prepareforyourcare.org and are available in Spanish as well as English. The National Institute of Aging has more information and tips on creating your plan: nia.nih.gov/health/advancecare-planning