Advance Directives: Why You Should Put Your Wish (cont.)
I wish there were a way for a doctor to help make this decision. My siblings and I have been talking about end-of-life directives but we're finding that none of us want to be the MPA for our parents. In other words, we don't want to be the one who decides to stop the support. How do you handle this?
I would think that the most important thing to realize is that in a medical crisis, the health care personnel or physician will always go to the patient first to get their opinion or wishes for what they want done. If the patient is unable to communicate those wishes, then the physician can rely on the living will. They will probably discuss the options with all the family members and will seek agreement among the family members before a decision is made. So it wouldn't necessarily be one person designated as power of attorney.
My suggestion would be that you go ahead and have the patient select one of the children -- or one of the children and an alternate -- with the idea that the pressure to make the decision wouldn't be solely on them, but the children could make those decisions together amongst themselves. Only if there were disagreement would the assigned power of attorney have to make the decision. It's always better to have someone assigned as a power of attorney. The other option might be if the children are unwilling to accept that role, then the patient may choose somebody outside the family or somebody distant in the family, like a brother or cousin, or somebody else.
How do I get my elderly parents to start filling out forms and deciding what they want?
The first thing would begin to establish a dialogue with your parents, discussing and asking what their wishes would be in certain situations. One might be if they had an acute medical crisis like a heart attack or stroke, or if they were diagnosed with a life-limiting illness. What would they like to be done? And then through the course of that dialogue, and you start to get their opinions and wishes, then you can obtain a copy of a living will and medical power of attorney forms that are valid in your state, and begin to discuss with them and have them complete those. It's always good to begin the dialogue and talk about it first before you actually sit down with forms to sign.
Is there somewhere you can file a hard copy so no matter what state you are in, the copy is readily available?
I am aware that some states are beginning to put together a state registry of living wills. I know Arizona started it effective December of 2004, but I'm not aware of other states that have begun to do that. I think in the next several years that will be a common occurrence. So you might check with your state. I know through Arizona it is handled through the secretary of state's office, but you can check with your health care office to see if your state has started a registry. What happens there is your living will document is recorded, and any hospital personnel can check that first to see if you've completed a living will or medical power of attorney.
Do these documents have to be drawn up by an attorney or are there "do-it-yourself" kits?
Advanced directive forms do not need to be completed by an attorney. They do require signatures of witnesses that are non-family or notarized, and there are many do-it-yourself advanced directive forms available. One place you can get those that are listed for individual states is VistaCare.com. They have a link to advanced directive forms or living will forms that are available free. You have to download the forms, print them, and complete them. There is other access to forms: you can go on Google and do a search for living will forms. Some are available free, others might cost $10-$15, but on www.vistacare.com, they are available free to download.
We are almost out of time. Dr. Swanson, before we wrap up for today, do you have any final comments for us?
Thank you for the opportunity to discuss this very timely and important topic. I would encourage everyone to begin to have discussions with your family members regarding advanced directives, and to obtain the forms, and complete them.
Unfortunately, in our country, only 20% of Americans currently have advanced directives, which leaves many of us extremely vulnerable should we encounter a life-threatening illness. Don't wait.
If you ask people why they don't do it, one of the main responses is, "I'm not old enough." The reality is that an accident may happen this afternoon and you will not have the opportunity to do it. The second response is often we just don't want to think about or talk about death or dying. But I think it's important for all of us to challenge that fear and begin to discuss that with our spouses, parents, and our children, so it can be a topic that we can freely discuss and communicate our wishes openly.
Thank you and I encourage all of you to act on this immediately and soon, for your own benefit and for your loved ones.
Thank you for joining us today, Dr. Swanson, and thank you members. For more information, please visit www.vistacare.com.
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