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Do You Have an Advance Directive?

April 10, 2012

Make Your Health Care Wishes Known

The situation is all too common. Someone is rushed to the hospital with a life-threatening medical emergency and he or she is too incapacitated to communicate and make decisions about their own care and treatment. Who will decide? Do loved ones even know what the individual would want?

You can avoid this scenario by completing a document called an advance directive, which spells out who will make decisions for you and what types of treatments you would or would not want, including diagnostic testing, surgical procedures, and cardiopulmonary resuscitation. It also makes your wishes known around organ donation.

When you are admitted to Washington Hospital for any reason, you are asked if you have an advance directive. If you do, it is put into your medical file. If not, you are provided with information about creating one.

"An advance directive empowers people to make their own health care decisions," said Doug Van Houten, a registered nurse at Washington Hospital. "It gives you a way to get what you want from the medical system, whether you are capable of speaking for yourself or not."

Washington Hospital is working to raise awareness about advance directives because they are the best way for patients to make their medical care preferences known, he added. On April 16, National Health Care Decisions Day, the hospital will have an information table where hospital staff, physicians, and the public can get their questions answered. The table will be staffed from 7:30 to 9:30 a.m., 11:30 a.m. to 1:30 p.m., and 4 to 6 p.m.

"We want hospital staff and physicians to be informed so they feel more comfortable talking about advanced directives with their patients," Van Houten said. "We also welcome the public to come in and learn more about it."

According to a study by the Pew Research Center, 71 percent of Americans have thought about their end-of-life preferences and 95 percent have heard of a living will (a type of advance health care directive), but only 29 percent have one.

"I actually think the percentage of people who have an advanced health care directive may be much lower," Van Houten said. "I have worked in critical care medicine for 30 years and I can tell you most patients don't have one. It really leaves family members struggling with how to make the best health care decisions for their loved one. Often they have never even talked about it before the medical crisis."

Putting it in Writing

Van Houten urges everyone over the age of 18 to consider putting their wishes in writing with an advance directive because life-threatening accidents and other medical emergencies can occur at any age.

"People often tell me that putting together an advance health care directive is a good idea, but they don't want to go to a lawyer or a notary," Van Houten said. "The truth is you don't need either for an advance directive. You can do it at home and you can get a friend or neighbor to serve as witnesses when you sign it. It doesn't need to be notarized to be legal."

There are a number of forms available to help you put your wishes in writing. Washington Hospital's website offers a link to a simple form provided by the California Hospital Association as well as a link to "Five Wishes," a more detailed advance health care directive. Five Wishes was created by Aging with Dignity, which charges a nominal fee (about $5) to use it.

In addition to designating someone who will make your health care decisions if you can't and what type of medical care you do or don't want, Five Wishes also stipulates the kind of comfort care you might want if you are terminal (hospice care or pain medications), how you want to be treated (someone to pray with you or hold your hand), and what you want your loved ones to know, because in a sudden medical emergency, you might never get the chance to talk with them again.

"Five Wishes is more comprehensive," Van Houten explained. "It provides more details about the care you would want and allows you to tell your loved ones things you might not have had a chance to tell them."

He said some people are afraid of advance directives because they confuse them with a DNR or Do Not Resuscitate order that some terminally ill patients have on file.

"An advance health care directive is a way for you to have a say about your care, whether that means you want every treatment option possible to prolong your life or not," Van Houten added. "It really is up to you and an advance directive lets everyone know your wishes, including your loved ones and your health care team."

For more information and links to advance health care directive forms, visit www.whhs.com/advance-directives.

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