Advance directives: Control over your care
February 09, 2016
A few months ago Dr. Douglas G. Merrill was faced with an
all-too-common situation. An elderly woman with end-stage
cancer suffered a stroke. Her only surviving relative
lived overseas and couldn’t be reached. Important and
difficult decisions regarding her care, such as whether she would want
life-sustaining treatment, were left to her doctors, who had never met
The patient did not have an advance directive—a simple document
that describes an individual’s healthcare wishes and designates a relative
or close friend to make decisions if the patient is incapacitated.
“An advance directive would have told us who she wanted to speak for
her,” says Merrill, chief medical officer of UC Irvine Medical Center. “In
this case, people who didn’t know her or what her desires were had to
make decisions for her.”
An advance directive is a legal document that explains what kinds
of healthcare you desire in case of a serious injury or illness. UC Irvine
Health patients are encouraged to complete an advance directive, which
becomes part of their medical records.
An advance directive can clarify such issues as whether you want
to be resuscitated if you become terminally ill or permanently
unconscious, or whether you want home hospice care instead of
being cared for in the hospital. At a minimum, you can simply name
an “agent”—a trusted person who will speak and provide consent for
medical decisions on your behalf.
“There are two parts to this,” Merrill explains. “You need to determine
who that person will be and then talk with that person about how you
want your care to go. Even when there are friends and relatives present when you are suffering, they often don’t know what you would have
wanted so they end up agonizing, or even arguing, over decisions.”
It’s not just aimed at end-of-life care, adds Dr. Aaron Kheriaty, an
associate professor of psychiatry and director of the medical ethics
program at UC Irvine School of Medicine.
“One of the myths is that advanced care is just planning about
end-of-life care,” he says. “There may be situations in which a person
is temporarily incapacitated, but there is a reasonable chance of
recovery.” Most people are comforted by the knowledge that they have
communicated their wishes in advance, he says.
“It can be hard to get the conversation going, but once you get people
talking you realize most people actually want to talk about it,” Kheriaty
says. “People feel empowered and relieved.”
Any adult can fill out an advance directive. It’s free, doesn’t require a
lawyer and can be revised if you change your mind about your care.
UCI Health has launched a comprehensive program to make it
easier for people to write advance directives. The program includes
training caregivers on discussing advance directives with patients and
free public classes to explain the document.
UCI Health physicians will encourage their patients to
discuss advance directives during office visits. The patient’s “agent” is
encouraged to attend this meeting.
“We want to answer patients’ questions accurately,” Kheriaty says.
“We want patients to express their values and what they want, so we
can honor their values. It’s not our role to impose upon them what we
think they ought to do. Advance directives are a key part of providing
care that is truly patient-centered.”
A class on advance directives
A one-hour class on advance directives will be held on March 17 and May 19, 11 a.m. to 12:30 p.m., at UC Irvine Douglas Hospital, 3rd floor, room 3005. A UCI Health doctor and social worker will explain what a healthcare directive form is and how it’s used. We will have forms for you to fill out in class. A notary public will also be available to notarize your completed form. Please bring your family and support persons with you to this important class.
For information or to register, call 877-UCI-DOCS (877-824-3627) or visit ucirvinehealth.org/planahead.
— UCI Health Marketing & Communications
Featured in UCI Health Live Well Magazine Winter 2016