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The Importance of Having Advance Directives

Advance directives are one of those things no one really wants to talk about, but which we all need – especially older people. And the urgent care that older people often need if they have COVID-19 has made the importance of advance directives even clearer. As research from West Virginia University points out, “COVID-19 has shoved life’s dark questions to the forefront: ‘What if I’m hooked to a ventilator and can’t speak?’ ‘If my heart stops beating, do I want to be resuscitated?’ Where do I want to die?’”

Advance directives are documents that lay out your preferences for healthcare, including end-of-life care. If you become unable to express your wishes about your treatment, your advance directives will guide doctors’ and families’ decision making. The National Institute on Aging (NIA) gives these examples of the type of care your advance directive might cover:

• CPR (cardiopulmonary resuscitation). Would you wish to be resuscitated if your heart stops beating? If not, your advance directive would include a “do not resuscitate” (DNR) order.
• Ventilator use. Would you wish for doctors to intubate you if you become unable to breathe on our own?
• Artificial nutrition (tube feeding) and artificial hydration (IV, or intravenous, fluids). Would you want these potentially life-saving measures?
• Comfort care. Would you prefer care (medication, testing, counseling) that would ease your discomfort?

You can also create a durable power of attorney for healthcare in which you name a person who will serve as your healthcare proxy. This is the person who would make decisions according to your wishes, if you are unable to communicate. You may choose the same person who is already your patient advocate (see this blog post from last month).

The NIA makes an important clarification about when advance directives are used:

“An advance directive is only used if you are in danger of dying and need certain emergency or special measures to keep you alive, but you are not able to make those decisions on your own. An advance directive allows you to make your wishes about medical treatment known.”

How to create an advance directive

The NIA recommends starting with a conversation with your doctor. Your doctor can help remind you, based on any conditions you currently have, what types of decisions you may have to consider. Your doctor or other healthcare provider will also have information about where you can find the right forms. You don’t need a lawyer and you don’t have to spend any money, although those are certainly options if you feel you need professional assistance. Guidelines for advance directives vary by state. Your local area agency on aging can direct you to the resources and documents you need.

Tell your family about these documents

Once you have these documents completed (and, by the way, you can always update or change them), let your family and your proxy know about them. Explain that these documents reflect your wishes should you become unable to communicate.