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End-of-life care: Do your loved ones know your wishes?

September 08, 2015 | UCI Health
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I have a goal before I retire: That every patient we see — no matter if he or she is in for surgery or an annual check-up — will have a discussion with us about creating an advance directive.

Many patients who stay at UCI Medical Center have not left written instructions for end-of-life care.

One reason more people don’t have an advance directive is likely because the conversation requires that we confront our mortality. It probably won’t be the most fun thing you do that day, but it may be the most important thing you can do for your family. We often forget that when we have not made these decisions, it is often left to a distraught loved one to do it for us.

Every adult should have an advance directive. You don’t have to be elderly or diagnosed with a terminal illness to have one. Too often I see apparently healthy young people admitted with life-threatening injuries or conditions. It can happen in the blink of an eye.

What is an advance directive?

An advance directive is a document that outlines your healthcare wishes if you become seriously ill or if you are in an accident and are unable to speak for yourself. With an advance directive, you can appoint a power of attorney (a relative or friend to make medical decisions for you), and you can specify which medical procedures you do or do not want performed.

Be advised that a living will only lays out what medical treatment you would like to receive in certain situations. In California, an advance healthcare directive allows you to create a living will and appoint someone to speak for you during medical situations.

Why is an advance directive important?

If a child is drowning at a swimming pool, we will, without question, perform CPR to try to save him or her. But if you’re late in life and have a terminal illness, do you want to go through that type of resuscitation? Who do you want to make that decision if you can’t? Does that person know what you want?

You might be surprised by what you learn when you have a conversation about these questions with a loved one.

I see wonderful, well-intentioned family members who find themselves having to make such difficult decisions — and they are unsure because they never talked with their loved one about these questions.

Having an advance care directive is one of the most important things you can do to help your family through a difficult time. Making your wishes known for end-of-life care eases the burden on your family. It’s an action that can provide you — and them — a measure of peace.

A community conversation

In La Crosse, Wis., 96% of the city’s adults have an advance directive. That is an impressive number to which we should aspire in Orange County, Calif. 

How did they do it? Local healthcare facilities, churches and community organizations recognized the importance of the issue and banded together to jump start the conversation.

It will take more than UCI Health to achieve that level of success. However, through partnerships with other hospitals, churches and community organizations in Orange County, we can spread the word about the importance of such conversations.

We are now training our nurses, social workers and physicians to have these conversations with families — something we didn’t learn in medical school.

We have developed and implemented a training program — using lectures, role-playing and videos, including the one created in La Crosse — that gives our healthcare providers the tools they need to start these conversations.

How do I create an advance directive?

The first step in creating an advance directive is to have a conversation with the person you want to speak for you later. Before you get into the more complex decisions about specific situations, think and talk about these questions:

  • What’s important to me?
  • What are my values?
  • How would I like that time of my life to go?

Once you’ve had that discussion, the remaining decisions will be easier to make.

You can download an informational document in English and Spanish. To be valid, advance directives need to be notarized or witnessed by two people. Your witnesses cannot include the person you are directing to speak for you, your family members or your healthcare provider.

Creating an advanced directive is pretty easy.

However, the most important part of an advance directive is the conversation. Have you and your loved ones had it yet?

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