Advance Directives Require Personal Choices

April 16 was National Healthcare Decisions Day, a day dedicated to raising awareness of advance care planning, and encouraging patients to express their wishes regarding health care. But what is advance care planning, and why would I need to do it, especially if I’m healthy and in the prime of my life?

Advance care planning includes completing advance directives, which are documents that describe your choices about care you do or do not want to receive, and how health care decisions should be made for you if you cannot express your wishes. Advance directives are personal; they express your personal wishes, beliefs and values.

Regardless of age or medical status, documenting your health care wishes and sharing those wishes with your agent in the event that you are medically ill or critically injured is important. If you are unable to talk or communicate, and haven’t done any advance care planning, you can’t be sure the care you receive is consistent with your wishes.

A Power of Attorney for Health Care is a document in which you appoint a person (your "agent," "surrogate" or "proxy") to make health care decisions for you in the event that you are not capable of making them yourself. Your agent or surrogate will make decisions for you based on your wishes or directions and their knowledge of your wishes or directions.

When completing the Power of Attorney for Health Care form, you can include specific instructions about the type of treatments you want or do not want, e.g. surgeries, medications, or to be placed on life support. The type of decisions the agent or surrogate can make depends on how you complete the form.

A Living Will, also called a declaration to physicians, is a document informing your physicians your wishes about life-sustaining measures to be used when you are near death or in a persistent vegetative state, i.e. treatments or machines that keep your heart, lungs, or kidneys functioning when they are unable to do so on their own.

Both your Power of Attorney for Health Care and Living Will are only activated when two physicians agree that you can no longer make your own health care decisions or choices. The difference between the two advance directives is that a Living Will only goes into effect when death is near or you are in a persistent vegetative state, and deals only with life-sustaining measures. A Power of Attorney for Health Care can go into effect any time you are incapacitated and can no longer make health care decisions, and is not limited to life-sustaining measures.

If questioning which document is more important, "as a social worker I recommended the Health Care Power of Attorney as it covers more health care situations," said Janet Bollig, medical social worker and senior business development specialist for Home Health United. You can certainly have both documents, but just make sure they don’t contradict each other.

Advance care planning is not just for the elderly or sick, either. Unforeseen circumstances can affect people of any age or health status – a car accident, childbirth complication, or illness can come out of nowhere. Without advance directives, you will still receive medical care, but there is a greater chance it will not be the types of care and treatments you want. A physician will generally look to your family and friends for decisions about your care, but if you haven’t had conversations about advance care planning with them, will they know what your wishes are?

The Terri Schiavo case is an example of why it’s important for even young, seemingly healthy individuals to have advance directives in place so loved ones know their wishes. A sudden cardiac arrest episode when she was only 26 years old led to a persistent vegetative state; what resulted were many motions, petitions, hearings, and a seven year delay before life support was finally terminated.

To learn more about advance directives in the state of Wisconsin, visit the Department of Health Services website at DHS.Wisconsin.gov. For help or questions regarding advance care planning or end-of-life needs, call 800-924-2273 for an informational visit with a Home Health United medical social worker.