Monday Medical: What to know about advance directives
For Steamboat Pilot & Today
STEAMBOAT SPRINGS — Working on your New Year’s resolutions? You might want to add making or updating advance directives to your list. These documents can take just minutes to create with the help of online resources and can give you and your family peace of mind.
Dr. Gary Breen, a hospitalist at UCHealth Yampa Valley Medical Center, outlines what you need to know about advance directives below.
What are advance directives?
These legal documents allow you to outline the type of medical care you’d want to receive if you’re unable to make decisions for yourself, for instance, if you’re in a coma or seriously injured.
“They allow the patient to spell out what their goals are as far as end-of-life care,” Breen said.
Power of attorney is an advance directive that allows patients to designate who they’d like to make medical decisions for them if they’re unable to, such as a spouse, family member or friend.
A living will is an advance directive that allows people to refuse or accept a variety of treatment options, such as artificial ventilation, feeding tubes, intravenous fluids and resuscitation.
Patients are encouraged to review their living wills with their primary care physician and to reach out if they have questions.
“Even if a patient doesn’t have family or they don’t have a medical proxy, they can fill out the document and talk to their primary care doctor about it,” Breen said. “If there are nuances, share those with your provider.”
A blueprint for care
While an advance directive can cover a variety of treatment options, it won’t cover every situation.
Though a patient may feel strongly that he doesn’t want a feeding tube, it might end up being very appropriate to use one for a week or two. On the other hand, if a patient wants to have eight days of life support but is brain-dead after a trauma, being on life support for that long may not be in line with her wishes.
“There is inherent ambiguity because of all the potential scenarios,” Breen said. “To me, an advance care directive is a blueprint for families or decision makers.”
How do I make an advance directive?
Historically, the document has been created with the help of an attorney, but now there are various online tools that patients can download and complete.
“They’re very brief,” Breen said. “I tried it recently, and the 13-page document took maybe five minutes to complete.”
Who should have one?
Every adult should consider having an advance directive. People may not think of making one until they’re faced with a serious illness, but Breen recommends being proactive.
“It can be hard for healthy 30- and 40-year-olds to be addressing this, but even in that population, you can’t predict trauma,” Breen said.
When should it be updated?
It can be helpful to review these documents every 10 years or if your health changes.
“As people get older and as significant medical diagnoses may occur, for instance, you’re diagnosed with an advanced form of cancer, it’s probably a good time to readdress it,” Breen said.
Why should I make an advance directive?
“We think it’s very important for patients to tell us what they want at the end of their lives,” Breen said.
It can also provide great comfort to a patient’s family when his or her wishes are clear.
For instance, consider a grandmother in her 90s with several medical conditions, who decides she doesn’t want to be on a ventilator or in the ICU for weeks on end.
“Her family can be that much more comfortable that this is what she would want or wouldn’t want, as opposed to saying, ‘Well, we don’t know what grandma would want,’” Breen said. “Very often, it’s the discussion that results from completing and talking about the advance care directive that matters more than what the document says.”
Through My Health Connection, the online patient portal for UCHealth, patients will soon be able to access an advance directive tool directly. In the meantime, access the tool at prepareforyourcare.org/advance-directive-state/co.
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