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Why you need an advance health care directive

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What kind of medical care would you want if you were too ill or injured to express your wishes? Without the ability to speak or write, or possibly even think clearly, how would you convey your wishes to your doctor or loved ones?

The overwhelming feeling of helplessness in the face of this dreadful situation is hard to imagine. Yet hundreds of thousands of Americans find themselves in this very situation each year — unable to communicate and without an advance directive.

An advance directive is a legal document outlining the type of medical care you wish to receive in the event that you are unable to communicate.

Not only does an advance directive offer you peace of mind, but it also takes the stress and burden off your loved ones who would otherwise be left to guess what you would have wanted.

When preparing an advance directive, it is also common to designate someone who can act on your behalf to make decisions regarding your health care, consistent with the wishes you have outlined in your advance directive.

This designated person is usually a family member or a close friend, and is referred to as a health care proxy or health care agent.

If you don’t have an advance directive or a designated health care agent, your doctors will consult your closest living family members to make the tough decisions about your care in the event you are not able to express yourself.

If your relatives can’t agree on your care or decisions can’t be reached in a timely manner, emotional stress and conflict among your family members is often the result.

Also, if none of your relatives are available or willing to make medical care decisions on your behalf, a court appointed representative who will not necessarily know your wishes or values may have to make critical choices for you.

According to the Department of Health and Human Services, only about one-third of Americans have an advance directive. Perhaps some people are uncomfortable discussing these tough choices. Others may think drafting an advance directive is complicated and don’t want to hassle with attorneys or associated costs.

No matter the reason behind the hesitation to secure an advance directive, everyone needs to put his or her wishes for end-of-life care or medical care in the event of a serious illness or injury, down in writing.

Who needs one?

Everyone. Everyone over the age 18, no matter his or her health status, should have an advance directive. Unexpected illnesses or injuries can strike at any time, and folks need to be prepared for such a tragedy. This includes having an advance directive in place so that doctors and family members can carry out your wishes.

How to create one

Despite popular belief, an attorney is not necessary to complete an advance directive. A legal written directive must be signed, dated and have a witness or notary.

In California, an easy way to complete an advance directive is to download the Advance Healthcare Directive document from the California Medical Association website (www.cmanet.org).

This form offers an introduction to advance directives, answers common questions regarding this document, and gives simple, step-by-step instructions for completing an advance directive.

While an attorney is not required, many people feel more comfortable creating an advance directive with the help of an attorney because it is imperative for the document to be written clearly for your wishes to be interpreted correctly.

Treatment choices

When outlining your treatment choices in an advance directive, it is important to think about different scenarios in which you would need treatment.

Common questions to answer in your advance directive include how you feel about the use of dialysis or breathing machines, if you want to be resuscitated if breathing or heartbeat stops, if you want to be tube fed, and if you want your organs or tissue to be donated.

What to do next

Make multiple copies of your completed and signed advance directive. Give copies to your health care agent, family members and anyone else who may be involved with your health care. Provide your doctor with the original signed copy so that it can be included in your medical records.

Keep a copy for yourself in a place that is easy to access, not locked in a safety deposit box or other locked location where others may not be able to access it in case of an emergency. If you are going to be admitted to a hospital or other health care facility, take a copy of the form with you in case your condition deteriorates.

End-of-life-care decisions are not easy, but that is why it is so important to make your wishes known in advance and help alleviate this incredible stress from your loved ones.

Even if you are in prime health and nowhere close to old age, be prepared for the worst. If tragedy strikes, both you and your loved ones will have enough pain and stress to deal with.

Paul Downey is the president and CEO of Senior Community Centers, a nonprofit agency dedicated to increasing the quality of life for San Diego seniors living in poverty. Learn more at www.servingseniors.org.

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