Advance Directives & End-of-Life Planning
It is difficult for people to make decisions when under pressure or emotional strain, particularly when there are no clear-cut answers. Issues such as the use of life-sustaining treatments and determining choices of health care require a great deal of discussion and careful thought.
It is our policy at Brown Clinic to provide high-quality medical care to all patients with the objective of saving and sustaining life. However, this commitment involves recognition that beginning and/or continuing treatment may not be in the patient's best interest when the burdens of such treatment outweigh the benefits. At these times, the objective is to allow as peaceful a death as possible.
Before a Time of Crisis
The best time to make an advance directive is when you are healthy, of sound mind, and not worried about a health condition. If you or your family member is seriously injured or becomes gravely ill, there may be difficult decisions to make about medical care, such as whether life-support systems should be used or withdrawn. It is important to learn about the choices of medical care and discuss the kinds of treatment you want before the need arises.
In addition to your doctor and nurses, there are local pastoral care staff and social workers that are ready to help with the emotional, moral and ethical concerns that accompany such decisions. We urge you to talk freely to any of these people.
Advance Medical Directives
Advance medical directives are legal forms that allow you to state your health care wishes in the event that you become unable to do so. These papers let others know about your wishes and can help guide your care. There are two kinds of Advance Directives: A Living Will
directs what treatment to provide or withhold when you are terminally ill or death is imminent or if you are permanently unconscious. It only becomes effective when you are no longer able to speak for yourself. A Durable Power of Attorney for Health Care
appoints someone to speak for you when you are no longer able to direct your care. If you improve and are able to speak for yourself, then you resume the ability to direct your care.
Get started with your advance care planning with the Brown Clinic's Health Care Planning Book:Health Care Planning Book
Without an Advance Directive your health care provider will turn to your family for decisions. They will start with your closest relatives, which may result in someone you would never select making decisions about your care.
Things to Consider
When making your Advance Directive, think about three possible situations:
- If you have a sudden illness.
- If you have a severe accident.
- If you become terminally ill.
In each of these situations, consider the following:
- Do you want aggressive treatment?
- How long would you want treatment to continue if you were unconscious and not expected to recover – days, weeks, months?
- When would care and comfort, with an emphasis on pain management, be your choice?
Write your requests clearly. If needed use extra space to write about specific treatment you do or do not want (i.e. the use of CPR or breathing machines). Make copies of your documents, and share them with your family members, spokesperson, attorney, physicians, hospital and anyone else involved in your health care.
Revisit your directives as you age and your health status changes. Your care decisions may change. If you want to make changes, complete a new form and communicate your wishes to all involved. Laws differ from state to state. If you are traveling or moving, you may need to adjust your information.