My dad designed an Advance Directive form thirty years ago for his patients. It is one page. It states things like, “If I have a terminal condition, in general, I would or would not want these things done” (for example, dialysis, feeding tube, cardio pulmonary resuscitation, antibiotics). In the state of Nebraska, where he resides, the page does not need to be notarized, it just requires a witness. He then asks his patients to discuss with their loved ones and send him a copy, and he saves it on file.
On multiple occasions, he has had to tell families, this is what my patient indicated to do in this scenario. Usually it’s the daughter from California who hasn’t been around. The siblings in Omaha have been there day to day, and they understand it’s time for their mom to pass. At the 11th hour, the daughter flies in and feels guilty she hasn’t been there. My dad must explain the directive and what her mother’s wishes were.
My dad talks about this with 100% of his patients, even the 20-year-old, healthy ones. When they are healthy, it’s a lot easier to talk about. About 90% of his patients have filled out the form, and he continues to bring it up, typically at their annual physical exam, with each patient who has not filled one out.
“Most people see the wisdom of it and are anxious to do it. Where it gets hairy is when you’re putting it into place. You may have a disagreement with family members, and you sit down to talk about it. You have to explain, ‘It’s not what you want, it’s what mom wants,’” my dad explained.
Furthermore, if he has a patient who is really sick and does not want to be resuscitated, he will have them write DNR (do not resuscitate) and put it on their refrigerator so first responders know that.
My dad’s dad had a “do not hospitalize” order, in addition to his DNR wish. This was something he and my dad (and his siblings) had discussed at length. He was living in a nursing home at 96 years-old.
When my dad received the call at 4am in 2005 that my grandpa had severe abdominal pain and rectal bleeding, he reminded the nursing home that his dad did not want to be hospitalized. They made him comfortable and let nature take its course. My grandpa died two days later.
When my dad suggests the “do not hospitalize” order to patients and their families, the inevitably say, “You can do that?!”
If you do not have these documents in place, each state has a plan for you if something happens (either incapacity or death), making your loved ones jump through legal hoops to be able to step in and help when you need it. For example, if you’re in a car accident and you do not have a Medical Power of Attorney or a Durable Power of Attorney, your loved ones must file a guardianship/conservatorship to make decisions on your behalf. It is time consuming and expensive. Instead of caring for you, they are left sitting in a lawyer’s office. Always a party.
If you’re thinking, “This doesn’t apply to me; I’m super healthy,” you are sorely mistaken. My friend and author Katie McKenna wrote a memoir called How to Get Run Over by a Truck. She was young and healthy and on a quick morning spin the day she was pummeled by an 18-wheeler. Thank God she lived to tell her story, which I highly recommend reading.
Death is the definition of inevitability. It’s the one guarantee in life. What are you doing for yourself and your loved ones to prepare? Ambiguity in your end of life care only leads to confusion, guilt and heartache for your loved ones.