April 13, 2022
Life is unpredictable; and though we don’t like thinking about it, accidents or illnesses can happen at any time to anyone, at any age. Because of this uncertainty, it is important to consider and document your wishes regarding medical treatment in the event you are ever incapacitated, or unable to speak and advocate for yourself. April 16 has been designated National Healthcare Decisions Day, which is meant to remind and empower people to create a plan.
“The plan is the creation of an advance directive,” explains Kim Pieretti, MSW, a social worker with Lee Health Q-Life Palliative Care. “An advance directive includes two parts: a living will and the designation of a health care surrogate.”
Ms. Pieretti explains that the living will contains instructions about whether you want life-prolonging procedures in the event you have a terminal condition, an end-stage condition or are in a persistent vegetative state.
“There are a couple of important things we want to make sure people understand about the living will,” Ms. Pieretti says. “First, is that the health care team does not look at someone’s living will unless they meet the criteria to do so and are unable to make their own decisions and cannot communicate with the health care team. Additionally, the living will does not address your code status – whether you want to be resuscitated or not. The ‘DNR’ – do not resuscitate form – comes from discussions with your doctor or medical team, it must be signed by both you and your doctor and should be uploaded to your electronic health record.”
Creating a living will helps alleviate future emotional burdens by making sure your wishes are known and followed. Ms. Pieretti stresses the importance of being prepared so your family is not in a position to determine what they should do and whether their wishes align with yours.
Lee Health uses the MyChart portal for patients to access their electronic health records, and Ms. Pieretti says there have been major upgrades to the Advance Care Planning section of the portal. Along with information and links to the planning resources, you can also upload your final documents to the site and answer questions for your family and the health care team that can help you think through what is most important to you when considering advance care planning. Ms. Pieretti recommends providing copies of your advance directive to your primary care provider and your health care surrogate, in addition to uploading the documents to your MyChart portal.
When it comes to designating a health care surrogate, this should be someone you trust to make decisions should you be unable to make them yourself. “It is crucial to have open, honest conversations with the person you choose, so you are, and they are, confident they will fulfill your wishes exactly as you outline them,” Ms. Pieretti says. “It is important to note, a health care surrogate has no financial obligation and is never responsible for hospital bills.”
Advance care planning is much more than simply signing paperwork; rather, it should involve serious conversation and discussion with the most important people in your life. Ms. Pieretti shares these tips to help you through conversations a lot of people may find difficult:
- Pick a time when everyone is relaxed to make it easier to listen to one another.
- Encourage loved ones to speak about preferences, and do not give up if they seem resistant.
- Before committing to anything, wholeheartedly evaluate motivation, availability and skills.
- Identify contributions that can be made comfortably and plan to assist or meet anticipated needs.
- Acknowledge limits to alleviate stress and uncertainty.
- Remember, solutions require collaborative efforts to provide the most quality of life and the most cost-effective care.
“All adults 18 years of age and older should have an advance directive,” Ms. Pieretti says. “Revisit the document throughout your life, especially as you go through different stages, like getting married and having children.”
In the state of Florida, it is especially important to have an advance directive because if you don't and you are incapacitated, state statute designates a health care proxy, which can be a guardian, a spouse, an adult child, an adult sibling, an adult relative, a close friend or a social worker. These people may or may not know your wishes, so an advance directive ensures that health care professionals follow your wishes without question.
You do not need a lawyer to make your wishes known or to complete these documents. Free forms and information are available for every state at www.nhdd.org or through our health system – go to www.LeeHealth.org and search ‘advance directives.’ Also, our Lee Health Q-Life Palliative Care team is always open to assisting staff or residents in the community with questions or concerns about medical directives.
By engaging in these important conversations and addressing any issues in advance, you and your loved ones know each other’s wishes and can ensure they are met, which provides peace of mind for everyone.