Cultivating Wellness by Talking About Choices: Advance Care Planning for Everyone Post #3

As I mentioned in my last post, Post #2:  Why Everyone Needs to Understand Advance Care Planning:  Even You, Advance Health Care Directives (AHCD) are the foundation of Advance Care Planning, so it’s essential to have a good understanding of what they are and how to complete them.  It’s also essential to know that if you are an adult, you need to have an Advance Directive.  I wish completing an AHCD were a commonly embraced rite of passage for everyone turning 18.  Register to vote and write your AHCD.

Advance Care Planning is not something most people are thinking about as they enter adulthood.  Most of us feel pretty invincible at 18 years old. But, alas, we are not. I hate to be the one to burst that bubble, and I don’t want to be a downer, but wouldn’t you rather take the time to attend to this and not need it than be the one who has an unexpected medical crisis and winds up with loved ones fighting in the ICU?  It’s like having car insurance. Most of the times we drive our cars, we make it home safely. My wish for you is that you never get in a car accident, but if you do, I sure hope you have good insurance.

Some of the specifics about AHCDs vary from state to state, so I’m going to speak broadly here while still telling you pretty much everything you need to know about these documents.  Hopefully, the following will answer all your most burning questions.

• What even IS an Advance Health Care Directive?  An AHCD is a legal document that identifies a health care agent (or proxy)–the person you choose to make medical decisions on your behalf if you are ever in a situation where you are unable to speak for yourself. It may also be called a Durable Power of Attorney for Health Care. Many AHCDs include some information about your health care wishes, which may also be referred to as a Living Will. I admit, all the different names for it can be confusing. The goal here is to legally document who should be allowed to make medical decision for you if you can’t do it yourself.

• What happens if I don’t have an AHCD? This is something that varies from state to state. In California, there is no default decision maker. It does not automatically go to your spouse or your nearest sibling or your oldest adult child. It would be up to your treating physician to determine who is most appropriate to fulfill that role, and often that means whoever shows up at the bedside. People usually assume decision making is deferred to their “next of kin,” but even that is not always clearly defined. So without an AHCD, it can be a bit of a free-for-all. If you are unsure about this, Google Terri Shiavo. (If you are anywhere near my age, you will remember her situation well, so I won’t go into it.)

• How do I decide who should be my health care agent? Normally you appoint a primary agent as well as a first and a second alternate agent, so you need to figure out who are the three people in your life best suited for this role. That can be tricky. I have to admit, my AHCD sat on my desk for years because I couldn’t decide who to put as my second alternate. (Finally I completed it without a second alternate. I figured a primary and one alternate is better than no one.) Again, people assume they need to appoint their next of kin or at least a family member, but you can choose any adult who is not your health care provider. I saw a patient once who had appointed her husband as a matter of course, but when we talked about her wishes, she was very clear about what she wanted, and he was very clear he disagreed and would not follow them. In another situation, a woman appointed her eldest son which was culturally expected, fully aware he too had no intention of following her wishes, but it was more important to her to put her eldest son in that role than it was to make sure her wishes were followed. Think about who you trust to be able to understand and represent your priorities in a medical setting–someone who “gets” you and won’t be afraid to advocate for you. Some people specifically choose someone outside their family to be their agent if they think that person will follow their wishes even if it goes against what the agent would want.

• Do I need an attorney to complete an AHCD? No. However, if you have seen an attorney to complete a trust, you most likely have an AHCD in the trust. In fact, I’ve never seen a trust without one. Look for the section that includes the words “health care.” People have often already completed this without even realizing it. If you don’t have a trust, there are many versions of the document you can fill out without an attorney. Google Advance Health Care Directive + your state and see what comes up. Many health care institutions have their own, but you don’t have to use theirs. My favorite is from Prepare for Your Care because it has the most useful and comprehensive options to document your wishes and has a version for each state:  https://prepareforyourcare.org/advance-directive. Check out their website for lots of useful information about Advance Care Planning including videos to help you consider your medical wishes. (More about that in my next post!) If you are filling out an AHCD form on your own, you will need to sign it with two witnesses who are not your agents or get it notarized. Everything you need to know about how to fill it out and make it a legal document will be written on the form. Easy peasy!

Now get started!  It always feels too soon until it’s too late.  And don’t worry about making the commitment to a specific choice of agents:  you can always complete a new AHCD in the future if your choice changes. It will be a relief to have it completed.