Advance directives: Control over your care

February 09, 2016
Advance directives

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 her before.

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 657-282-6357 or visit

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Featured in UCI Health Live Well Magazine Winter 2016

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