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My Wishes, My Way – Steps to Ensure Your Advance Directives Are Honored

It happens too often. A health care emergency occurs; panic ensues, and the patient’s end-of-life wishes take a back seat to established protocols to extend life. Failing to honor a patient’s advance directives can increase the individual’s discomfort and prolong the dying process – the opposite of what the patient wanted.

As professional advisors, we understand how strongly our clients want their advance directives to be honored. That’s why we remind individuals of all ages – from young adults age 18 and over, to seniors approaching 100 – how many things may thwart their end-of-life wishes.

What possibly can go wrong?  Let us count the ways.  Medical personnel may not know about the patient’s Living Will or DNR Order.  The healthcare surrogate named in the estate planning documents may have died or become incapacitated.  Poor decisions often result because the healthcare surrogate is in denial as to the true state of the loved one’s medical condition, or is overwrought with grief and exhaustion.  Most tragic for the patient?  The healthcare surrogate, despite the patient’s wishes, is emotionally unprepared to “let go” and orders unwanted life-sustaining treatment.

If you are a baby boomer benefitting from the “longevity boom,” you want to do it “My Way,” and specify your final wishes.  It’s disconcerting to learn that, while the number of patients with advance directives has increased substantially over the last 15 years, a recent study found that many Americans with advance directives undergo more invasive care at life’s end than desired.

Q: What’s the solution?   A: Communication.

Your chances for success rest on how effectively and how often you communicate your wishes. Below are steps you can take to help ensure your final wishes are followed:

1. Have the Conversation: Discuss your end-of-life wishes now with your family and loved ones.  Do it before you lose cognition and before a medical crisis occurs.  Ask your loved ones to repeat back to you what they heard you say.  Role-play scenarios and conversations.  Ask your surrogate, “If the doctor asks, ‘Should I intubate your Mother,’ what will you say?”  “If the doctor says, ‘If I don’t intubate your Mother RIGHT NOW, she will die,’ how will you respond?”

2. Blame it on NHDD (April 16): If you are searching for ways to open up the lines of communication with your loved ones on this difficult topic, blame it on National Healthcare Decisions Day (April 16).  Send family members a link to the NHDD website or to my previous article on this topic, and let them know you’d like to discuss your expectations regarding your end-of-life care.

3. Document Your Wishes and Name a Healthcare Surrogate: Update your estate plan to include a Living Will and a Healthcare Surrogate. Discuss with the people you name to act on your behalf how important this role is to you.  Being named healthcare proxy should never come as a surprise.  If it has been a number of years since you and your healthcare surrogate have discussed your wishes, renew the conversation.  Does your surrogate have any misgivings?  Your surrogate has a duty to you to follow your wishes and refuse extraordinary medical procedures to prolong your dying process. Will your agent’s religious beliefs interfere with that duty.

4. Keep Documents Updated and Readily Accessible: Be sure to inform your healthcare surrogate and loved ones of the location of your advance directives and other important legal documents.  Better yet, give them a copy now.

5. Remind Your Healthcare Surrogate That It’s What You Want, Not What He Wants:

A healthcare surrogate has a responsibility to know the details of your wishes. Your agent must be prepared to enforce your wishes during a medical crisis or when the agent may not be emotionally ready to let go.  Remind your agent that when the time comes, it’s not what he wants, but what youwant.

6. Inform Your Medical Team: Remind your medical professionals of your expectations relating to your end-of-life care at each and every appointment. Review your chart to confirm that your advance directives have been noted.

Preparing advance directives and naming a healthcare surrogate merely are the initial steps toward ensuring that your final wishes will be honored.  Communicate, document, update, and remind your loved ones.  It’s important that you have peace of mind that your wishes will be known and honored when the time comes.

Have you had major changes in your family dynamics or circumstances?  Do your estate plan and advance directives need to be updated?  Please call our office at 407-622-1900 to arrange an appointment.

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