Dr. Cheryl Woodson

Woodsonian Thoughts on Thursday: How To Age Excellently. Keep Control with Advance Directives

Advance directives keep you in control during a life-threatening condition, but they also make your illness easier on your family. Instead of leaving them alone with the anxiety and guilt of making tough decisions, in a sense, you are there, holding their hands, reassuring them. Review advance directives with your advocate and family at least yearly to be sure the documents reflect your current wishes, and that everyone understands what you want.
Remember, your welfare is more important than hurt feelings. Your advocate doesn’t have to be your spouse, the oldest child, or even a blood relative, as long as you trust the person, she knows your wishes and is of legal age.
Emotions run high when a loved one is seriously ill, and families can really beat up your advocate. To avoid this, prepare a document that she can hold up, saying, “This is what Dad told me to do.” Families may not like what you chose, or whom you chose, but your welfare is more important than hurt feelings. People cannot interfere unless they prove (in court) that your representative is not following your directions.
Holidays are great times to discuss advance directives as a family. Start with an example of a previously healthy person in the family, or on the news who was injured, or became ill suddenly. Express grief that the confusion, anger, and guilt probably meant that “their family will never have another Happy Thanksgiving.” Point out how much easier it would have been if the sick person had taken time to prepare an advance directive. Explain to younger adults that this is just a rite of adult passage (like registering to vote.) Older adults usually hate imagining the destruction of the family they worked so hard to create. They may also be more cooperative when you emphasize that this gives them control. Some families even tease a senior, saying, “You don’t want ME to decide, do you? You better tell me what you want me to do.” That worked in my family.
Do Not Resuscitate Orders (DNR) are not advance directives. Doctors should recommend DNR when cardiopulmonary resuscitation (CPR) will not change the reason that someone is dying. CPR was designed to correct sudden dangerous and abnormal heart beats, or to sustain the heart until doctors fixed a correctable heart condition. Research does not support the use of CPR in situations where the heart is too damaged to heal, or when it is not the primary problem. In end-stage conditions like congestive heart failure, metastatic cancer, dementia, stroke, chronic lung or kidney disease, and other non- heart-related illnesses, CPR does not prolong life, it prolongs dying.
Allow Natural Death (AND)
The term DNR can leave the impression that families could have done something to prevent the death, but chose not to. Guilt can force them to refuse this decision, even when further treatment would be futile, or even abusive. Hospice professionals developed the term AND to present a more positive choice. However, both terms can be too vague to confirm the person’s wishes, or to describe procedures would support quality of life a specific situation. More comprehensive and descriptive documents like P.O.L.S.T. offer a clear advantage.
DO NOT WAIT until someone is deathly ill, and it is too late to learn their wishes. Don’t become seriously ill without preparing an advance directive, or your state’s surrogate decision-making laws will apply. That usually means that two doctors can decide your fate, even if they’ve never met you. Also, you might be surprised about whom your state considers “next of kin.” Give and get directions in advance to make sure that strangers don’t decide and the decision-maker is your choice. Prepare an advance directive so your loved ones don’t have to make rushed, emotional decisions, suffering the additional weight of regret on top of their grief. Stay in control and make it easier for them. Let them “hear” your voice and follow your directions.

Next Thursday: Put Your Hands on the Wheel and Drive Your Weight Healthy

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