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Why is having an Advance Directive for Health Care important?

  • mediculous
  • Aug 28, 2018
  • 3 min read

Many of us do not think about unpleasant, difficult situations when things are going well. However what we often fail to think about is that unexpected situations can happen anytime in life. As a medical professional, I have seen many young healthy adults with no medical problems get into an accident or get affected by unexpected health problems which affects their quality of life. In such situations we might not be in a state to be able to choose or make medical decisions. I have seen patients breathing on ventilators and surviving on tube feedings for years without any quality of life.

Families and loved ones often face a hard time to make a decision, especially difficult decisions.

They often feel guilty to decide that its time to stop medical management even when they realise that the prognosis is poor.

We all have different preferences and wishes in life and having a living will or durable power of attorney helps medical professionals to respect your wishes and provide the care you wanted and it ease the burden on your loved ones.

What is a Living Will ?

Living will is a written document that states your wishes on how you want to be cared if you are unable to make decisions. It includes topics such as resuscitation, breathing with the help of the ventilator, tube feedings and treatments that you do not want to receive. This document helps your medical provider to decide how they should approach your treatment. Being specific as possible helps with providing your desired treatment.

What is a Medical Power of Attorney ?

The durable power of attorney (DPOA) for health care document states the person you would want to make medical decisions for you, when you are not able to make decisions for yourself. This person should be some one you trust and they should be aware of your wishes and values. Although living will is a great way to express your wishes , it cannot cover every circumstances. This is where having a DPOA in addition to having a living will can be helpful.

Can you change a living will?

You can cancel or make changes to your living will at any time as long as you can think rationally and can communicate your wishes. When you make changes you should sign and notarize the document to make it legal.

Important topics to discuss in your living will

Do Not Resuscitate (DNR)

If you happen to experience a situation where your heart stops beating or you stop breathing, medical professionals will perform cardiopulmonary resuscitation (CPR) where they will do chest compression and use medications to restart it. DNR is an order stating that you do not prefer life saving CPR or resuscitation measures.

Do Not Intubate

If you experience difficulty in breathing and if symptoms does not improve with less invasive measures the next step is to intubate and connect it to a machine to help you breath. Intubation is the placement of a tube into the mouth in order to have it enter your windpipe to help you breathe. Intubation can be performed in many cases and most of them are temporary, however in some situations they can be intubated and connected to a ventilator for months to years. Some of the temporary situations include, during surgery under anesthesia, during CPR or when some one is experiencing short term loss of consciousness such as an acute intoxication. Long term intubation will be required if you have a severe lung problem or multiple comorbidities which increase the complications. You will be able to mention specific scenarios in which you do not want to be intubated ( such as long term mechanical ventilation) in your living will.

Tube Feeding

If you are in a state where you are unconscious or unable to eat Artificial nutrients and fluids can be given via tube feeding. Sometimes people can survive for years with tube feedings and mechanical ventilation. However when some one with a serious life threatening illness in stops eating or drinking, it is sign that the body is beginning to stop functioning.

How can you prepare an advanced directive / Living will ?

You do not need a lawyer to fill out a living will or DPOA. Your medical doctor will be able to help you fill out your wishes and answer any questions to help you make the best decisions. Your doctors office or public health department in your state or hospitals will be able to provide you with the required form.

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