Advance Care Directives: Making End-of-Life Decisions

by Paulette Avery RN, MSN

As difficult as it is for most of us, thinking about and planning for end-of-life medical care is something we all would be wise to do. As defined by the Medline Plus medical encyclopedia, advanced care directives are "specific instructions, prepared in advance, that are intended to direct a person's medical care if he or she becomes unable to do so in the future."

The Terri Schiavo case graphically illustrates the horrors that can unfold when family members are unclear about the wishes of a critically ill or injured loved one who is unable to express his or her wishes about the use of life-support measures. And although most people believe it is a good idea to have some form of advance directive, the majority of people have not completed the documents for themselves.

Regardless of your age, and even if you choose not to complete any legal documents, it is a good idea to think about your wishes should you become unable to make medical decisions for yourself. Talk about the issue with family members, close friends, and your doctor, and let them all know your desires. Consider whether or not you would want CPR in the case of respiratory or cardiac arrest. Would you want your life maintained by artificial nutrition via tube feedings or intravenous lines? What about the use of a respirator if you were unable to breathe on your own? Would you want blood transfusions? Do you want to die in a hospital, or would you prefer to be at home? These are just a few of the questions to consider, and answering them may require that you do research to learn more about the options and their consequences. It will definitely require you to carefully consider the options and what each means to you.

If you choose to use legal documents, there are two main types, a living will and a medical power of attorney. The living will spells out your answers to questions such as those listed earlier. The medical power of attorney designates the person you choose to make health-care decisions for you if you become unable to do so for yourself. This could be a spouse, one of your children, or a trusted friend.

The topic of advance-care directives is complex, and I have only touched on it here, but I hope I have started you thinking and planning for yourself. Many resources exist to help you explore this area in more depth and assist you in completing the necessary legal documents. Your own doctor is a good place to begin the discussion. In addition, these organizations are a few of those available to provide information and help with this area of health care:

Aging with Dignity, 1-888-5-WISHES or www.agingwithdignity.org

Caring Connections, 1-800-658-8898 or www.caringinfo.org

National Hospice and Palliative Care Organization, 1-800-646-6460 or www.nhpco.org

Paulette Avery is a registered nurse and a freelance writer specializing in health care issues.