April 16, 2016 is National Healthcare Decisions Day (NHDD). While there may be no parades or fanfare, we should all pay attention to this special day. National Healthcare Decisions Day reminds us how important it is to complete or review our Advance Directives (ADs).
These documents indicate whom we appoint to make financial, healthcare and end-of-life decisions for us in the event that we are unable to make those decisions for ourselves, and what those decisions might be. Advance Directives are needed to ensure that choices we make about our own futures will be adhered to.
The following is a brief guide to Advance Directives, with answers to some of the most frequently asked questions regarding them. More information can be obtained from Phelps Memorial Hospital Center, your healthcare provider, your legal advisor, a local government office, and the NHDD website, www.nhdd.com.
What are Advance Directives?
Advance Directives pertain to three main areas:
• The appointment of someone (known as a “proxy,” “agent“ or “surrogate”) to be your voice in making decisions for you. You can appoint alternate proxies.
• A Health Care Proxy can make healthcare decisions for you if you – whether temporarily or permanently – are deemed incapable of speaking for yourself.
• Durable Power of Attorney can make financial transactions on your behalf.
• A “living will” to document the kinds of treatments you would want at the end of life.
• Decision-making directives about specific situations, which include “Do Not Resuscitate” and “Do Not Intubate” orders, Organ Donation wishes and Medical Orders about Life Sustaining Treatment (MOLST).
How do I obtain Advance Directives?
It’s easy to obtain Health Care Proxy and Living Will forms on the following websites: www.nhdd.org; www.health.ny.gov/forms; www.1nyc.gov (includes forms in English, Spanish, Chinese and Russian), www.caringinfo.org; www.ag.ny.gov (includes explanation of the different forms). The forms vary from state to state. In New York State, the Health Care Proxy and Living Will forms do not need to be notarized or reviewed by an attorney. They do need to be co-signed by two witnesses, and you must be over the age of 18 to complete them.
Medical Orders for Life Sustaining Treatment (MOLST) is a New York State advance directive to be completed by you and your doctor. It is available through your physician or hospital.
How do I have a discussion about Advance Directives and healthcare and end-of-life wishes with my family?
The biggest barrier to completing Advance Directives is likely our reluctance to discuss these issues and to think about a time when we or our loved ones might be incapacitated. We are worried about upsetting each other, especially when it comes to talking about end-of–life.
Yet this discussion is vital, because the person who is going to act on your behalf needs clarity about your wishes. Otherwise, that person may have difficulty making choices, or the situation may cause bad feelings. Sometimes it is better to choose a trusted person outside of your family to be your Health Care Proxy to avoid conflicts and protect your loved ones from the burden of difficult decision-making.
Discussions about our healthcare and financial wishes can be some of the most meaningful we have with our families. Not only can these discussions help avoid confusion in the future, they can deepen our understanding of and empathy for each other. It makes us feel secure to know that we will be able to support and help each other when we need it most.
It is best to have discussions about advance directives when all the relevant people are present and there are no distractions. Sometimes it is not possible to have a calm, open conversation about these concerns, and the decision-making may become contentious. A neutral person such as a family mediator who is trained to facilitate this type of dialogue can help in such cases. Referrals to family mediators in your area can be obtained through the Academy of Professional Family Mediators at www.apfmnet.org or 952- 999-3437 or the Family and Divorce Mediation Council of Greater New York at www.fdmcgny.org.
I don’t need an Advance Directive; I trust my family and healthcare provider to make the right choices when the time comes.
What you consider “the right choice” may be different in the eyes of others. Not having Advance Directives can potentially put a lot of stress on your family or providers, who might have to guess what your wishes would be, often at a time of crisis and emotional turmoil. Your family members may disagree on what to do, which can lead to long-standing arguments or feelings of remorse and guilt. In addition, when there are no Advance Directives, healthcare providers may be forced to pursue expensive treatments and care that do not always meet the desires or best interests of the patient.
I already have Advance Directives. Do I need to update them?
Advance Directives do not have a time limit; they remain valid until you revoke or replace them. However they should be reviewed periodically, with the following
• Are your Proxies or Powers of Attorney still available and willing to act?
• Have your wishes changed since the last time you reviewed your Advance Directives?
• Does your Proxy really understand your wishes?
• Has your family composition or relationships changed? If your Proxy or Power of Attorney is your spouse and you have since divorced, you need to redo your Advance Directives.
• Are your documents in a safe place, and easily accessible if needed?
National Healthcare Decisions Day is a good time to review these and other important documents!
Please join us on Wednesday, April 13, 2016 from 11:00 am-2:00 pm outside the Phelps Memorial Hospital Cafeteria, where members of the Phelps Hospice team will be available to answer your questions about Advance Directives. Forms will be available in English and Spanish. For more information, contact Phelps Hospice at (914) 366-3325.