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September 2017: The Importance of Advanced Directives for Hospice and Palliative Care Patients

When someone is suffering a chronic illness, is in severe pain or facing the end of his life, there are many decisions that must be made around treatment and palliative care options. But, this is often a stressful time for the patient and loved ones, and people may be too ill or unable to express their wishes around the kind of medical care they want. With so many issues swirling around them, and to avoid confusion or conflict among family, friends and healthcare providers, an advanced directive is an important document to have.

In short, an advanced directive is a legal document that spells out a person’s personal desires regarding the kind of medical treatment or end-of-life care he or she wishes in the event it becomes impossible or too difficult to convey those wishes on one’s own. 

The advance directive goes into effect when the patient is incapacitated and unable to state preferred types of medical care; it also provides the opportunity to express one’s values and desires that relate to end-of-life care. Some decisions that may come up at that time include those regarding nutrition and hydration (feeding tubes, IV fluids), use of a ventilator, CPR and the use of defibrillators (and the “DNR” or “do not resuscitate” order), and the types of comfort care that will be desired.

Creating your advance medical directive
You do not need to be dealing with a medical condition to write an advance directive—this important legal document is something that can be created at any age and when you are healthy. 

The first step in creating your advance directive is to give careful consideration to the type of treatment you would want—or not want—in the event of a medical emergency and at the end of life. Talking with your healthcare provider can help you understand the various scenarios that could arise, shed light on your treatment options and help you determine what is in your best interests and/or aligned with your values. Your personal values around how you would want to spend time in the case of an incapacitating illness, vegetative state or during a terminal illness will guide your decisions.

People script out what they want to happen should their heart stop, if they have trouble breathing, if they can no longer feed or care for themselves, if a medical procedure leaves them with a life-altering condition, or if they are nearing the end of their life and wish to spend those days in the most meaningful way possible. Some people may feel that all medically possible interventions are the way to go; others may prefer no “heroic measures” or other interventions at all.

Depending on your age and your particular situation, you will have different ideas about what to state in your advance medical directive. If you have drawn one up at an earlier age and in good health, and are now much older and dealing with medical issues or terminal illness, you should update your advance directive to reflect your current wishes. That way, your loved ones and medical providers will have a clear picture of what you want in any situation that may arise, to that you can receive (or not receive) medical treatment on your terms. If you are going into hospice care, this will be a crucial part of your patient care plan. Planning ahead for these situations is never pleasant but they will spare you and your loved ones distress at a time when you’ll want to spend quality time with them instead.