Today is the 9th Annual National Healthcare Decision Day (NHDD), so if you’ve never thought about whether you’d prefer to die in a hospital or at home, this is the day to start making plans.
According to studies, less than a third of Americans have let anyone know their end of life wishes in a clear and legal manner while still able to communicate their own choices. This is despite the fact that at least one study revealed that more than two-thirds of individuals age 18 or older want those decisions respected. Part of the problem is due to a lack of knowledge about so-called “advance directives”.
Aware of the obvious need for better education, attorney Nathan A. Kottkamp founded National Healthcare Decisions Day 9 years ago after several years of success in his state of Virginia,.The goal of what has now become a grassroots collaborative effort of national state and community organizations is to encourage every American adult to talk about their advance care desires with family, friends and healthcare providers before a health crisis occurs. Only by making informed and thoughtful decisions ahead of time, can the number of tragedies that occur when a patient’s wishes are unknown be reduced.
For example, someone with a very aggressive form of cancer might want to opt out of chemotherapy or radiation that would at best extend that person’s life for a very short time in favor of palliative or hospice care. In order for that persons’ specific desires to be carried out, they need to be written in an advance directive. Ideally this advanced directive would be shared with all family members. That way no one has to guess what healthcare treatment or care that individual has chosen. This is especially important in the event that he or she is unable to communicate or actively participate in the decision making. Open communication and a shared understanding about individual values and preferences for treatment can lead to a plan of care that is consistent without any second guessing.
“In one study of ICU patients with terminal conditions, between 65 and 76 percent of physicians whose patients had an advance directive were not even aware that it existed,” said Mr. Kottkamp. “These findings show that there is a huge communication gap between patients and their doctors around end of life care, NHDD’s mission is to help close that gap.”
In addition to where you would choose to die, Mr. Kottkamp has suggested several other questions to think about as part of the conversation:
-What makes your life most meaningful?
-What does being “healthy” mean for you?
-What scares you most about being sick?
– What scares you most about dying?
– Have you had experiences that have shaped the way you think about disability and/or death?
– On a scale of 1 to 5, how would you rate:
• Let me die without medical intervention
• Don’t give up on me no matter what
• Try any unproven intervention possible
– Could a loved one correctly describe how you’d like to be treated in case of a terminal illness?
– Is there someone you trust who you’ve appointed to advocate on your behalf when the time is near?
– Have you completed any of the following:
• a written living will
• appointed a healthcare power of attorney
• completed an advance directive
Advance care directives are not necessarily the same in every state.In Florida, they can include any of 3 documents:
— A living will – a written or legally recognized oral statement made while you are mentally competent, instructing your physician whether you do or don’t want life-sustaining procedures if you should become terminally ill or have an end-stage medical condition. This is especially critical to have if you are an irreversible coma and can not communicate your desires.
–Healthcare surrogate – a person you choose in advance to make medical decisions on your behalf if you are suddenly unable to communicate your own wishes. Without this document, the state of Florida will assign a proxy (Statute 764)
–Durable power of attorney- a document allowing you to name a person to act of your behalf, handling your legal and medical affairs should you become unable to do so for yourself. The document needs to specify how broad the responsibilities of the named individual will be.
Advance directives are legally valid throughout the United States. While you do not need a lawyer to fill out an advance directive, your advance directive becomes legally valid as soon as you sign them in front of the required witnesses. Advance directives do not expire, but remain in effect until the document is changed. Completing a new advance directive, invalidates the previous one. So review your advance directives periodically to ensure that they still reflect your wishes. If you want to change anything in an advance directive once you have completed it, you should complete a whole new document.
Although some states honor advance directives from another state, not every state does. For Floridians who spend lots of time in more than one state, it is probably wise to complete the advance directives for all the states in which you spend a significant amount of time.
Many people don’t realize that Emergency Medical Technicians (EMTs) cannot honor living wills or medical powers of attorney. Once emergency personnel have been called, they must do what is necessary to stabilize a person for transfer to a hospital, both from accident sites and from a home or other facility. Only after a physician fully evaluates the person’s condition and determines the underlying conditions, can advance directives be implemented
Because less than half of Floridians have advanced directives, one of the goals of today’s initiative is to provide information as to where to obtain the proper forms.
The Florida-based non-profit organization Aging with Dignity is one such resource, distributing Five Wishes, an easy-to-understand advance directives written in plain language. It meets the legal requirements of Florida and is available in 26 languages including Braille.
For more information: For free information and tools, visit the National Healthcare Decisions Day website
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