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Seminar Discusses Advance Directives, Hospice & Palliative Care

The great Indian leader Mahatma Ghandi, whose profound messages influenced the world, offered the advice, “Live as if you were to die tomorrow. Learn as if you were to live forever.”

Most of us don’t want to think about the inevitability of death, let alone prepare for it or talk about it. If you were to suffer a devastating illness or accident that left you incapable of expressing your preferences, would your family and friends know what sort of medical treatments and procedures you would wish to have?

“When we’re healthy, most of us tend to procrastinate in planning for end-of-life care – including hospice care – or for palliative care to alleviate pain during an extended illness, but these critical situations can turn on a dime,” says Washington Hospital’s Spiritual Care Coordinator Michelle Hedding, MA, RN, CHPN (certified hospice and palliative care nurse). “A document called an ‘advance health care directive’ lets your loved ones know exactly what your wishes are.”

Hedding notes that in a 2012 survey of Californians conducted by the California HealthCare Foundation, 60 percent of people said that making sure their family is not burdened by tough decisions is “extremely important, yet 56 percent had not communicated their end-of-life wishes to their families. The same survey found that 82 percent of people said it is important to put their wishes in writing, but only 23 percent had actually done it.

To help people in the community learn more about advance health care directives, hospice care and palliative care, Washington Hospital is offering a free seminar on Tuesday, April 28, from 6 to 8 p.m. The seminar, which will feature a presentation by Hedding and time for questions and answers, will take place in the Conrad E. Anderson, M.D., Auditorium, located in the Washington West building at 2500 Mowry Avenue in Fremont.

“Advance directives, hospice and palliative care are personal choices about how you live, even as you face an incapacitating illness or death,” Hedding stresses.

Advance Health Care Directives Put Your Wishes in Writing

An advance health care directive lets you specify your wishes, such as whether you want your life prolonged by any means necessary or you prefer to have some treatments withheld. The advance directive also designates an “agent” – and possibly alternate agents – who should make medical decisions for you and provides instructions for what treatments you would or would not want.

At Washington Hospital, all patients are asked if they have an advance directive when they are admitted to the hospital. If patients do not have an advance directive, they are provided with information about creating one.

“The best time to fill out an advance directive is when you are healthy and in a good frame of mind, not at a hospital when you’re already facing a health care crisis,” Hedding notes. “Anyone over age 18 should have an advance directive. Life-threatening medical emergencies can happen at any time, and at any age.”

Options for Advance Health Care Directives

At the seminar, Hedding will go into detail about the standard advance directive form available at Washington Hospital. She also will discuss other forms for advance directives that are available online, such as “Five Wishes,” a more detailed advance health care directive that also covers the personal, emotional and spiritual needs of the person, not just the medical and legal issues.

“The most important thing in creating your advance directive is to name the person you want to serve as your agent to speak on your behalf,” Hedding says. “It’s a good idea to name up to two alternative agents in case your first choice of agent is unable to make health care decisions for you for some reason.”

California requires that advance directives be witnessed by two people who know the individual making the advance directive. One of those witnesses cannot be related by blood, marriage or adoption, and neither witness can be designated as the agent. The individual’s physicians, nurses or other health care providers are not allowed as witnesses. Alternatively, the advanced directive can be notarized.

You can revoke or revise your advance directive at any time.

“An advance health care directive is not cast in stone,” Hedding explains. “The advance directive can always be revised if you change your mind or if your health situation changes. We will follow the instructions in the most recent version of your advance directive.”

Hospice Care and Its History

The concept of hospice as a program to care for the dying emerged in the late 1960s in London. The word “hospice” was borrowed from way stations for pilgrims to the Holy Land in the Middle Ages. The first hospice in the U.S., the Connecticut Hospice, was established in 1974, and hospice care became more widespread throughout the U.S. in the 1980s.

“Hospice care, which was created to care for patients with a limited life expectancy of six months, provides comprehensive support of the patient’s body, mind and spirit,” Hedding explains. “Hospice also supports the patient’s family and friends in the dying and bereavement process.”

Hedding stresses that rather than being a “death sentence,” hospice is a service that helps to support a high quality of life, in line with the wishes of patients for whatever time they have to live.

Dame Cicely Saunders, founder of St. Christopher’s Hospice in London, noted: “You matter because you are you. You matter to the last moment of your life, and we will do all we can, not only to help you die peacefully, but to live until you die.”

Palliative Care and Its Relationship to Hospice

Palliative care emerged from the hospice movement, providing specialized care for people living with serious illness, with a focus on relief from suffering. The first U.S. hospital-based palliative care programs began in the late 1980s.

“Palliative care is not just for patients who have cancer or are dying,” Hedding says. “It is an extra layer of medical support that can be offered at all stages of the illness – the earlier, the better. Palliative care can be offered simultaneously with some curative treatments, with those treatments ending when a person is transferred to hospice.”

Hospice and palliative care both are family-centered services that take a holistic approach to caring for patients and focus on symptom management. Both types of care involve an interdisciplinary team of professionals in spiritual care, social work and medical care to deal with all aspects of the patient’s needs.

“I consider palliative care and hospice care to be good nursing care and good medical care, as well as spiritual care,” Hedding says. “They embody a philosophy of care that focuses on the whole person. You are a human being with all kinds of aspects to your life. With hospice and palliative care, the care providers strive to be attentive to all aspects of who the person is.”

Learn More

To register for the free seminar on April 28, visit, or call 800.963.7070.

Washington Hospital offers assistance to people who wish to create an advance health care directive. Health Insurance Information Service Coordinator Kristi Caracappa is available Monday through Friday from 8 a.m. to 5 p.m. by phone or in person. Call 510.494.7005. Her office is located at Washington West, 2500 Mowry Avenue, Suite 100, in Fremont.

For more information, visit You also can learn more about Advance Health Care Directives and the “Five Wishes” at and