Today we continue “DRops of Wisdom,” our physician blog, with Dr. Stewart W. Stein, the associate vice president of medical services for Chapters Health System. He describes the importance of advance directives and how everyone has the right to make healthcare decisions.
Advance Directives
The majority of Americans view voting for elected officials on Election Day as their right. They get to decide on the welfare of their communities, states and country. Equally important are healthcare decisions. When it comes to a person’s health and well-being, everyone has the right to decide whether to seek or refuse medical treatment. Many adults all across the United States, however, do not exercise their right to decide.
Often times, healthcare decisions are made for adults who have become incapacitated—a result of suffering a debilitating stroke, or of developing dementia—by loved ones. Family members might assume they know the individual’s wishes and make healthcare decisions that their loved ones might not have chosen were they able to do so.
How does someone make their healthcare wishes known? They can map out their wishes in the form of an advance directive. An advance directive is the overall plan of a person’s healthcare wishes, that is to say, how much or how little should be done when he or she might not be able to make decisions. Components of an advance directive can include a living will, a healthcare surrogate designation and an anatomical donation.
Despite the fact that the Federal government passed the Patient Self-Determination Act in 1990 requiring hospitals, nursing homes, home health agencies and health maintenance organizations (HMOs) to provide patients with information about healthcare decision-making rights, only about one third of Americans have completed an advance directive. According to a University of Pennsylvania study, researchers discovered that a completed living will had been prepared in only 29.3 percent of cases, and only 33.4 percent of patients had identified a healthcare surrogate. A fully executed advance directive was statistically higher in patients with chronic illnesses compared with their healthy counterparts.
The rationale behind an advance directive is to help ensure that treatment preferences are honored if someone becomes incapacitated and can no longer speak for himself or herself. An advance directive can avoid potential conflicts.
Right to Decide
It is best to make sure that healthcare decisions are in the form of a written statement, or an oral statement made when you are healthy. There are three types of advance directives, which can be executed as part of advance care or estate planning.
A living will is a statement of your wishes with regard to medical treatment in circumstances under which you can no longer express consent. It’s called a living will because it takes effect while you are still living.
A healthcare surrogate is a person designated by you to make and authorize healthcare-related decisions on your behalf. You can include specific instructions about any treatment you want or do not want, similar to what you might have expressed in a living will.
With the passing of Florida Statute 765, you can now choose an immediate healthcare surrogate while you maintain mental capacity. Your choice of a healthcare surrogate can be based on culture or life choice. You also have the right to agree to, or to refuse, any decision made by your healthcare surrogate.
An anatomical donation is a document where you indicate your wish to donate at death all or part of your body. This donation can be an organ, tissue or body, to a person in need or for healthcare training.
It is entirely your choice as to what you want to complete for an advance directive. You can complete one or all three of the previously described options.
If you want your wishes known, start by taking the time to have conversations with your family and physician. If you need assistance in getting the conversation started, staff at all affiliates of Chapters Health — Chapters Health Hospice, Good Shepherd Hospice, Hospice of Okeechobee, HPH Hospice and LifePath Hospice — are available to help.
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