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Advance Directives

As you probably know, you can rarely get people to do something they don't want to do. If your loved one is reluctant to discuss this, you can try to figure out why and try to address it. For example, if the person doesn't "want to think about death," you can point out that you're really talking about quality of life, not death, and promise to keep the conversation as brief as possible.

If you still meet with refusal, don't push the issue too much. Be ready to drop the subject if the person gets angry or upset, but explain that you'll want to discuss it later. Then follow up. If you know your loved one's doctor or religious adviser, you can ask him or her for help.

It's never easy to talk about serious illness, disability, or death. But a little bit of uncomfortable conversation can make all the difference should you--or a loved one--become unable to express your health care preferences. It's most important that you talk with your health care agent (the person you appoint to speak for you, should you be unable to speak for yourself) and your doctor about your wishes, but you also may want to share your desires with other family members. Finally, be sure to update people--and your forms--if your wishes change.

Talking with Your Health Care Agent

Before you appoint someone as your health care agent (or alternate agent), make sure that person understands your wishes and is willing to carry them out. If he or she objects to one of your decisions, you might want to think about designating someone else. A good way to organize your thoughts for this conversation is to fill out a generic living will and use it to explain what decisions you've made and why. Also discuss any religious beliefs that might impact your thinking on end-of-life matters and your general hopes for your medical care. It might be good to let other family members know about your decisions, too, so they don't feel left out or surprised in case your agent does need to make decisions for you.

Don't forget that no matter how hard you and your agent find this conversation to be, not having your wishes spelled out will create more stress in the long run. Watching a loved one get sick is one of life's major stressors. Being responsible for making choices about the medical care of that person is difficult to begin with, and not knowing what choices the person would have made further increases stress. So talking about what kind of care you would want and putting those choices in writing are important not only for your peace of mind, but for your family's as well.

Talking with Your Doctor

If a doctor disagrees with a patient's wishes, he or she does not have to carry them out, but is obligated to find a doctor who will. To avoid this complication, make sure your doctor knows about--and is comfortable with--your decisions.

Schedule an appointment specifically to go over your completed advance care directive, or tell the receptionist that you want extra time to discuss them during your next appointment.

In addition to the items covered in your directive--especially the kind of treatments you would want and how you would like to treat pain-- make sure your doctor is aware of how much you would like to know about your condition should you become very ill. Some people want to know everything, while others would prefer only the basics. Also note how much information you want shared with your loved ones.

In addition, your doctor can be a great resource for questions about medical treatments that you'd like answered before you fill out your directive. He or she also may be able to tell you what medical problems you may face given your medical history.

Once you've completed your advance care directive, ask your doctor to keep copies in your medical file and to make a note in the file about the conversations you've had. Also periodically make sure he or she has the current contact information for your health care agent, if you have one.

Source: Harvard Health Publications, Cambridge, MA.
 

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