Monday, August 17, 2009

Advance Medical Directives--Resources

When I decided to write about Advance Medical Directives (AMD), I had not foreseen that this topic would be a centerpiece of the current public debate about health care reform. All the talk in the news, on blogs, and in town-hall meetings whether invoking the myth (not reality) of government "death panels" or debating the merits of insurer-paid consulting for end-of-life decisions--all this talk is about what we have been discussing over the last few posts.

Advance Medical Directives. A statement of what procedures and health care you would like if you are unable to physically express your preferences. As I've said before, these decisions are numerous and can be complicated. I've recommended that you consult all the resources available, such as a doctor, social worker or an eldercare attorney to help you decide what will be best. If your insurance coverage will pay for such consultation, all the better.

Let's look at some final subjects concerning the AMD.

Special Issues
• Both Your Parents Are Alive
If both your parents are still alive, it is possible that each of them, independently, may have written a Will and Advance Directives, but have never discussed these documents with each other, let alone with you. You may have to speak with each parent separately to discover where the documents are and their content.

• Second Marriages; Blended Families
The same communication caution applies if one or both of your parents have entered into second marriages.
  • There may be communication barriers because you are related to only one of the couple. Your stepbrothers and stepsisters may face the same barriers with your parent.
  • If there is some evidence that your parent and her spouse have prepared separate documents, it may be best to talk with each parent away from the other so that you can learn the truth about the documentation, not what your parent told his or her spouse.

• The Directives and Other Documents
  • The Advance Medical Directives are always written in a document separate from a Will or a Durable Power of Attorney. The Directives may be attached to these other documents or the other documents may refer to them. The Advance Medical Directives may stand alone.
  • A Will may be drawn up for a couple or for an individual. Advance Medical Directives, however, are always written for the individual. A Will for a married couple would then refer to two Directives.
  • A Durable Power of Attorney is drawn up only for an individual, so it will refer to only one Advance Medical Directives statement.

Talking about the end of life is a difficult subject. In our society, we have been taught to fear death. However, death is a natural and inevitable part of life. In fact, it is the last rite of passage.

Keep the Advance Medical Directives in mind as your parent ages. Express your wishes. This may encourage him to express his own choices.
• If your parent is reluctant to be specific about his wishes, prepare your own statement and share it with him.
• If your parent is making out a will or trust, ask if Advance Directives will be part of it. Ask to see the final document.
• Remind your parent that Advance Directives are for her benefit, as well as yours. Whom would she choose to make such decisions if she can’t--a stranger? Or will she retain some control over the process by expressing her choices now?

Finally, if your parent refuses to discuss this and has not written any statement of Advance Directives, continue to seek out information. Conversations with your parent’s contacts, though difficult, may give you a hint of how your parent feels. Realize that your parent’s reluctance may come from deep sources of fear or discomfort of which you are unaware. Be firm, but not stubborn; be gentle and loving, but persistent in the face of her humanity.

To Read More
Laurence, Michael J. A Matter of Life and Death: Informed Advance Health Care Directives., Inc. 2007.

Schneiderman, Lawrence J. Embracing Our Mortality: Hard Choices in an Age of Medical Miracles. Oxford University Press, 2008.

“Advance Directives for Health Care Decision Making”., Department of Health, Advance Directives. Accessed 8/17/2009.
Compares Advance Directives with Living Wills and Power of Attorney.

Aetna/InteliHealth Web Site. Under “Your Health” click on “More” > “Caregiving” > “Caring for Seniors” > See articles on End-of-Life Decision-Making and Living Wills. Accessed 8/17/2009.

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