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Published on April 19, 2019

What Are Advance Directives and Who Needs Them

What Are Advance Directives and Who Needs ThemIn this Fox 8 House Call series, Cone Health experts discuss advance directives, including:

Advance Directives: What They Are and Who Needs Them

Although it is a subject most individuals want to avoid, it is extremely important to talk to your family about your end-of-life health care. By default, physicians continue treating individuals to keep them alive for as long as possible, because without consent from the patient or surrogate, they usually do not switch to a comfort care approach to treatment. In these instances, an extremely difficult decision of choosing a treatment approach is left to family members. Family members can feel the stress and responsibility of making the right decision for their relative complicated by uncertainty about what the person would want, and feelings of grief and/or guilt. Understanding our wishes and values helps family members who are left to make decisions when we are no longer able.

North Carolina and federal laws give every competent adult the right to make their own health care decisions. As important legal documents, advance health care directives describe the medical care you want. They help your family, friends and doctors carry out your wishes even if you’re unable to communicate them. Preparing advance medical directives gives adults the opportunity to declare in advance what medical treatment and decisions they want for themselves if they are unconscious or otherwise unable to express their wishes during a serious illness or terminal situation.

Advances in medical technology have made it possible to keep people alive well beyond the point where their lives may have meaning and quality to them. Patients who can’t communicate their wishes regarding their medical care may be kept alive by heart-lung resuscitation, breathing machines, artificial feeding and other methods. Many people view this as postponing death rather than sustaining life. This is why advance directives are so important.

Advance medical directives should be discussed in depth with family to establish full understanding of the wishes, beliefs and values of the individual preparing the documents. Cone Health supports a competent adult’s right to make decisions to accept or refuse medical, surgical or mental health treatment, and encourages individuals in the community to prepare advance medical directives.

Bob Hamilton, M.Div., BCC, has been the director of Cone Health’s Department for Spiritual Care and Wholeness since 1979. Hamilton is also a long-standing member of the Cone Health Ethics Committee, which is focused on patients’ rights. He is a 1969 graduate of Duke University Divinity School and earned a Master of Divinity from Episcopal Seminary in Virginia in 1970.

Advance Directives: You’ve Completed the Documents, Now What?

An advance directive is a written statement of a person's wishes regarding medical treatment, often including a living will, made to ensure those wishes are carried out should the person be unable to communicate them to a doctor. Once you’ve completed your advance directive documents, keep the original signed document in a secure but accessible place. Do not put the original document in a safe deposit box or any other security box that would keep others from having access to it.

Make sure you give a copy to everyone who has been a part of your advance directive discussion and documentation. Bring a copy to your health care team – this includes all of your physicians.

Mind My Health is a new, free online tool and partnership Cone Health is participating in that makes it easy to fill out and manage your advance directives online.

Your advance directive is a fluid, dynamic discussion, and completing the documents is not the end. You should always revisit and talk about them, making any necessary adjustments as your health care plan changes. Be sure to talk to your family, doctors, clergy and friends about your wishes, particularly if your medical condition changes.

Now that you’ve educated yourself and completed your advance directives, you can be a great resource for your family, friends and faith community. Start the discussion about the importance of creating advance directive documents, sharing what you did and what worked for you.

Sue Ellen Grounds, MSN, RN-BC, CHPN, is a palliative care clinical nurse specialist at Cone Health. She received a Bachelor of Science in nursing and a master’s degree in nursing from Western Governors University. Grounds has more than 30 years of nursing experience, focusing on palliative care for the last 10 years.

Advance Directives: Importance of End-of-Life Care Conversations

End-of-life planning is a hard topic for many families to talk about, but it is very important and necessary. Eighty million American families reported that they haven’t talked about any end-of-life issues together, and 70% of end-of-life conversations happen because of a health crisis or emergency event. End-of-life plans need to be carefully made. Otherwise, families have to make important decisions without having time to think them through. Most people report feeling relieved after having these talks.

By planning ahead, you can get the medical care you want, avoid unnecessary suffering and relieve caregivers of having to make decisions at times of crisis or grief.

Living wills and other advance directives are written, legal instructions about your wishes for medical care if you can’t make decisions for yourself. Advance directives guide doctors and caregivers if you're terminally ill, seriously injured, in a coma, in the late stages of dementia or near the end of life. By creating these documents, you can be clear about the choices you would want people to make on your behalf.

Being prepared is key, and the sooner a person talks about their wishes with family, the better because we never know when something will happen. Meet with your health care provider to create or review your advance directives. Talking about your wishes with your family and health care provider beforehand can help everyone understand what you want.

Elizabeth Golding, DO, is the medical director of Cone Health Palliative Medicine Services and a member of Cone Health Medical Group. She completed medical school at Virginia College of Osteopathic Medicine and her residency at Cone Health’s Moses H. Cone Memorial Hospital.

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