Loyola University internist advises patients to complete their living wills

On April 16, Americans are being urged to complete living wills and other types of "advance directives" in observance of National Health-care Decisions Day.

All adults who have the capacity to make decisions should document what health care decisions they would desire if they became incapacitated, said Dr. Laura Saelinger-Shafer of Loyola University Health System. Saelinger-Shafer is an internist who has a special interest in geriatrics.

"It can be difficult for people to talk about such issues, especially when they are still healthy," Saelinger-Shafer said. "But health-care decisions are easier to make ahead of time, when it's not a crisis situation. An advance directive relieves loved ones from the burden of having to make decisions for patients when they are very ill."

Saelinger-Shafer advises her patients to discuss their wishes with their families and doctors and to bring advance directive documents to their doctors. (In Illinois, advance directive forms are available from the Illinois Department of Public Health web site, www.idph.state.il.us).

There are several types of advance directive documents. They include:
Health Care Power of Attorney. This designates whom you would like to make health-care decisions for you if you are unable to do so yourself. It also states whether, for example, you would like to be an organ donor or have life-sustaining treatments, such as artificial nutrition and hydration (feeding tubes).

Living Will. This takes effect if you become terminally ill or permanently unconscious or lapse into a vegetative state and are unable to make decisions for yourself. The document states that you would not want any procedures done if they only would prolong the dying process. The living will should be signed, dated and witnessed by two people.

Do-Not-Resusciate Order. This states you do not want cardiopulmonary resuscitation if your heart stops and you stop breathing. Your doctor signs this order and you are given a copy to carry with you and post in your home to ensure that your wishes are known. Measures to promote patient comfort and dignity will be provided.

Mental Health Treatment Preference Declaration. This states whether you would want to receive electroconvulsive treatment or psychotropic medicine if you have a mental illness.

If you change your mind about your preferences, you may alter the instructions at any time. Any changes should be signed and dated, and copies given to your family and physician. You also can change who you name power of attorney for health care. Or you can void the document by destroying it.

Federal law requires hospitals and other health-care providers that receive Medicare funding to ask patients if they have advance directives. Centers must inform patients about their health care decision-making rights, educate their staff and community and not discriminate against patients based on their advance directives.

If you do not have an advance directive, health-care decisions will be made by your family, doctor and hospital. Many hospitals have ethics committees to help make end-of-life decisions. But final decisions are left up to the patient, family and physician.

"Even if you are young and healthy," Saelinger-Shafer said, "it is important that you take the time to think about and discuss your wishes with your physician and loved ones."

Source: Loyola University Health System