Directives can shine light on loved one’s wishes

Planning ahead could save family and loved ones additional grief in times of stress and uncertainty.

Advance care planning is a formal process focused on making your wishes known on how you would like to be cared for by your healthcare providers, and ensuring that the providers respect those wishes, whatever they may be. This also removes the guess work from friends and family who are often tasked with making medical decisions during such stressful times.

Dr. Margaret Elizondo is a board-certified physician in family medicine, hospice and palliative care at Sharp HospiceCare, and lives in San Diego. She said California’s Advanced Directive is a combination of what once was called a Living Will, where you can list in advance what you would or would not want to be done in certain circumstances.

“Typically, it would be, ‘I do not want to be kept alive on a ventilator or with a feeding tube. If I am not able to be aware and interact with my family and friends anymore,’” she said. “Unfortunately, medicine is so complicated, and there are so many things that can happen to us, and different ways that our bodies can be kept alive these days by modern medicine, it is hard to predict what might happen and what you would want under certain circumstances. Our Advanced Directive in California includes the durable power of attorney for healthcare. So, it is both a Living Will type document, and it also lets you assign other people to make decisions about your medical treatments if you are not able to speak for yourself.”

This is a powerful document, said Elizondo, but unfortunately, many people have only done a “boilerplate” verbiage in a standard advanced directive, which covers limited circumstances people find themselves in such as an irreversible coma and do not want to be kept alive with artificial means.

“So many times, there are things that fall short of an irreversible coma where people would not want to proceed with more medical treatments,” she said.

“The idea is that this agent to make your healthcare decisions would be able to step in and make those decisions for you if you cannot do it. You also have the option to write-in on your advanced directive and have an attorney or paralegal make a document for you that goes beyond the boilerplate language.”

Elizondo said this includes things like having metastatic cancer and not wanting further treatment but wanting hospice care. She said making more specific information available makes it much easier for people who might have to take care of them later in life, as they would know what their end of life wishes are.

“Also, when you assign an agent to make decisions for you, you must make sure that person really can make the decisions that you would want,” she said.

“That means that you would have to talk to them about what you would want or not want. You cannot assume that they know.”