Thinking Ahead: Advance Directives

Advance directives, those legal documents that spell out your wishes for end-of-life care, are not something most people want to discuss, which is why many of us wait until a time of crisis to think about them. But it’s in a time of calm that we should be thinking about what type of medical care we would want if we were suddenly injured, or if we were too ill to make decisions for ourselves, and discussing these wishes with our families or others we trust. The more people who know what your wishes are, and whom you trust to make those decisions for you, the more likely it is that they will be carried out if the need should arise.

But how do you have that conversation with the people you love? It’s easier than you think. By printing the health care proxy forms off the internet (you can get a full explanation and the form at http://www.health.ny.gov/forms/doh-1430.pdf), you have a tool in front of you to use in guiding that discussion. This legal document lets you consider your own wishes, and spell them out for others to follow. In addition, it helps you decide the best person or persons to carry out your wishes, should you be unable to make those decisions for yourself.

Advance directives generally involve up to two documents: a living will, and/or a health care proxy. In New York state, unless the living will specifically names a proxy to act as your health care agent, a living will is extremely limiting, so for this blog we will discuss the health care proxy form only, which does the job of both the living will and the health care proxy.

The health care proxy document allows you to name your health care agent or agents, as well as accept or refuse medical care based on a specific set of circumstances. In addition, you can make decisions about

• The use of dialysis and breathing machines
• Your wishes about being resuscitated if your breathing or heartbeat stops
• Tube feeding
• Organ or tissue donation

I like to suggest that every adult over the age of 18 should complete their Advance Directives. Once a child is old enough to go away to college, he or she should have the privilege to choose who their proxy should be, and have a discussion with him or her about their beliefs and wishes at end of life. It is also vital that you revisit these documents from time to time, and update them as necessary. You can always name a new proxy, and update your wishes.

But, as was recently noted in The New Old Age Blog (http://newoldage.blogs.nytimes.com/2013/10/17/wheres-that-advance-care-directive/?_r=0) in The New York Times, filling out the forms is only the beginning, since the forms do no good if no one knows where to find them. Upon choosing your health care proxy or proxies, at the very minimum, each one should have a copy of the paperwork. In addition, you should have one in an easy-to-locate spot, in case it needs to be accessed quickly. I suggest keeping one in the glove compartment of your car as well, for easy access should it be needed.

By having the difficult discussions before a crisis, you can be sure that your wishes are carried out.

By Dorian Froelich, LMSW

Dorian is the Director of Social Work and Admissions at the Gurwin Jewish Nursing & Rehabilitation Center. For more information, visit www.gurwin.org.