I've heard this from patients or their families a thousand times: “you know, we have the paper work for that at home, but we just have not gotten around to filling it out”. I'm talking about what is known as the advanced directive (AD).

The AD is actually composed of two parts, the living will and the durable power of attorney (DPOA) for health care, sometimes called a health care proxy. The former is the written expression of one's care wishes at the end of life. The latter is the legal designation for a surrogate decision maker in the event that one is no longer able to make decisions themselves.

Many of us have had a discussion with a spouse or friend, somewhat along these lines: “well, I sure hope if I get real sick they don't stick me on life support forever.” Realizing that the scenarios, the ethics and the circumstances to be infinitely complex and highly personal, we owe it to ourselves and our loved ones to have these difficult and critical discussions in advance, and get our wishes on paper. Why? Because if we don't, we risk putting some very heavy decisions on family members at the worst possible time – during a critical illness. Furthermore, we risk their making decisions in our stead that we may have objected to. I have seen this tear families apart time and again. Rather than rallying at the bedside, families are torn apart by an avoidable and too-late debate on “what mom would have wanted.”

There are many resources out there, and no excuse for not having completed your AD. You do not need a lawyer. You can scribble this on the back of a grocery bag if you are so inclined, though I don't recommend this! You will need two witnesses to your signature of the documents, at least in most states. There are sometimes state to state differences in terminology, the need or not for a notarized signature, and so on, so do a little homework. The following link is for the State of Montana form, called “My Choices”: http://www.doj.mt.gov/consumer/consumer/forms/advancedirective.pdf

I think this is a pretty good form. It's certainly not the only one around. There are bare bones as well as exceedingly detailed ones to be found, in terms of the living will section. Personally, and from experience, I think people should strongly consider putting more detailed language into their directives, especially as it relates to tough questions such as the use and duration of feeding tubes, the use and duration of antibiotics in otherwise terminal situations, whether to continue the administration of important medications in otherwise terminal situations, and so on.

The most important thing is to have the conversation. Ask your parents (or your kids!) if they have done their advanced directives. Schedule a couple hours to have that tough talk – even if it gets emotional or contentious, I guarantee that you will come out of it closer to your loved ones, and with a huge weight lifted. You may not agree with what your brother decided, but you must respect that he DID decide, and can rest easier knowing that those wishes will be – must be - honored.

Your primary care provider can be a great resource for questions you may have on this subject. If they have not brought it up to you yet, don't be afraid to broach the idea of the AD at your next checkup. When you are done, make a bunch of copies – for your files, family members, your DPOA, as well as for your health care provider and primary hospital. Montana has a central registry where you can “house” your AD for password-accessible reference. This can be invaluable, especially for those who travel a lot or don't want to cart around the paperwork. Here is the link: http://www.doj.mt.gov/consumer/consumer/advancedirectives.asp

More to come in the future on related issues: The Good Death, hospice, and an “enhancement” on the living will, called a POLST form.

Stan Seagraves M.D., an internist who has practiced in Missoula for over 20 years. He is currently practicing hospital medicine at St. Patrick Hospital, and is medical director of their hospitalist program.

Good news!

Stan Seagraves, M.D. wrote a second installment, again advising families on steps they can take so pain and difficulties can be averted, or at least minimized...[READ MORE]

SPECIAL GUEST COMMENTARY: This contribution was made solely for the benefit of readers of this web-site and is not an endorsement of GIIG, it’s products or services.