Making the right choice: The importance of advance care planning

My mom was eating Cheetos when she asked me this question: “Why would I need an advance directive? I’m not dying. Aren’t you supposed to create one of those thingies if you’re in the hospital or something?” She ran her fingers down the margin of an advance directive that I had handed her, looking at me with furrowed-eyebrows and skepticism in between her glances at the Gilmore Girls episode she was watching.

I responded, “Well, an advance care plan, including advance directives, are a good thing for everyone to have, whether you are healthy or not. At any age, you could get sick and be unable to make healthcare decisions. Advance directives allow you to communicate for yourself if or when you cannot.”

Advance care planning. Big words. Sort of scary words. However, they really shouldn’t be scary words. Making an advance care plan means making decisions (and communicating those decisions) about the care you would want to receive if you become unable to speak for yourself. Advance directives are documents that allow you to put those wishes into writing, which can then be communicated to physicians and your healthcare team.

Why would you want to create an advance care plan? There are several reasons:

• To relieve your family of having to make tough decisions for you
• To make sure you receive the treatment you want
• To help guide your doctors about who you are and what you consider important for an acceptable quality-of-life
• In the absence of these documents, your family and your healthcare professionals have to guess about your treatment preferences

Creating an advance care plan

There are many great resources out there to help you write an advance care plan. Consider reading The National Institute on Aging’s recommendations for how to make your wishes known. We also like Houston Methodist Hospital’s Advance Care Planning worksheet, which can help guide clinicians and your families about the types of activities that are important to you.  Be sure to make copies of these documents once you complete them and provide these copies to your family and your primary care doctor.

Some of you reading this might be family members of prospective patients. Maybe you have a grandfather who is very healthy, but you anticipate that he may need to be hospitalized over the next few years. Whether you are the person completing advance directives or a family member of someone you hope will complete them, starting the conversation is not easy.

Although I do this sort of thing for a career, even I had difficulties initiating the conversation with my Cheetos-eating, Gilmore Girls-watching mother. I would encourage you to visit BeginTheConversation.org or the University of Pittsburgh Medical Center for tips on starting the conversation. They provide suggestions on words to use, the circumstances in which you should consider approaching the conversation, and ways to redirect the conversation.

If I still haven’t convinced you, remember this: As someone who works in hospitals addressing or resolving ethical uncertainties or value-laden conflicts, there are few things more challenging for families than having to make decisions for a loved one who never expressed his or her treatment preferences.

The one quote that will always stick in my mind is from an adult daughter of a patient who said, “I am thankful daddy took the time to tell us what he wanted. I feel I can do right by him in honoring his wishes.”

-By Courtenay Bruce, assistant professor of medical ethics at Baylor College of Medicine’s Center for Medical Ethics and Health Policy

Over the next two months, PolicyWise will discuss topics relating to medical decision making that will be featured in the Jan. 17 performance of “Let Me Down Easy” by Anna Deavere Smith. Tickets can be purchased online for the performance only or the VIP dinner package, which includes a facilitated dinner discussion with audience members.