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Advance Directives: What Your Loved Ones Need To Know

Mrinalini sarkarWhen it comes to healthcare decisions, most of us know what we would want for ourselves, but what if – due to illness or an unexpected accident – you’re unable to make them? Would your loved ones know what medical decisions to make for you if you couldn’t speak for yourself? If not, now is the time to create an advance directive, a legal document that provides directions and a voice for your medical care when you can’t. 

Most Americans support the idea of having an advance directive but, according to a 2014 study published in the American Journal of Preventive Medicine, fewer than one-third of respondents had one.

In recognition of National Healthcare Decisions Day (celebrated tomorrow), we spoke with Mrinalini Sarkar, MBBS, a hospitalist at the Hospital of the University of Pennsylvania (HUP) who has served on the hospital’s ethics committee, to learn more about advance directives, including who should have one, where to start, and why it’s so important. 

What is an advance directive?

An advance directive comprises two parts: the living will (which states the treatments you do or don’t want , for example, IV fluids or pain medication) and the naming of a healthcare power of attorney or proxy. Having both is important. Living wills only speak to certain situations, for example, when a patient has a terminal or irreversible condition [like a coma]. The proxy is your advocate, able to speak directly with the healthcare team about what you’d want. 

Living wills and healthcare proxies vary from state to state so it’s important that you complete one for the state(s) where you spend a significant amount of time. (Click here to find your state’s form.)                                                                                  

Aren’t advance directives only for older people?

No! All people 18 or older should have these documents. An unexpected medical emergency can happen at any time, to anyone. Don’t wait until you or a loved one is sick—and emotions are running high—to have this conversation. 

How do I choose a healthcare proxy?

The proxy can be any adult person whom you trust, who shares your beliefs, and who will be willing – and available—to take on this responsibility. It can be a family member, close friend or even a member of the clergy. The proxy cannot, however, be a member of your healthcare team. 

A healthcare proxy can actually be part of a person’s healthcare conversation at any time, depending on the patient’s wishes. When you designate a person, you can give as much authority as you feel comfortable with.

How do I get started?

The first step is talking with family members—and your primary care physician—about what medical treatment you’d want if you couldn’t speak for yourself.  Resources on the National Healthcare Decisions Day website will help guide you as to what should be included in the document. 

If you complete the directive online, you must print out a copy and sign it. While an advance directive doesn’t need to be notarized, it should be witnessed by two people (not the care provider or named proxy). Then, keep it in a safe place and make sure you tell—and give a copy to—everyone who was part of the discussion. 

Can an advance directive be changed?

Yes, it can be revised at any time, but you need to create a new advance directive that has been witnessed.  Don’t just alter the original. Be sure to tell those who should know about the new document and give them copies. 

What is HUP doing to raise awareness of this important issue?

On Healthcare Decisions Day, HUP will set up tables offering a wide spectrum of information for staff, patients, and visitors, including advance directives, palliative care, and organ donation. In addition, doctors, social workers, nurses and others will be available to answer questions about these important topics. 

I will be conducting a survey, asking staff about whether or not they have advance directives. I have found that very few healthcare workers do have this important document. We see the dilemmas and distress family members go through with patients, how these decisions play out, but yet think it won’t happen to us. But what if the patient were your own father or family member? 

Everyone has the right to make choices in health care. Creating an advance directive should be as much a priority as discussing your next career move or buying a house. 

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