“If you knew when your life would end, would you want to know?” is a question many people contemplate. A medical emergency can add other considerations to that question. Will anything happen that is beyond your control? Will your health care wishes be carried out? Having an advance directive can bring you and your loved ones peace of mind.
Thanks to advances in medicine and technology, most of us aren’t rushed into end-of-life decisions. However, discussions about those decisions—before they’re needed—still should take place. Mercy Pastoral Care Chaplain Larry Conrad works with patients and families in critical care units at Mercy Medical Center – Des Moines. Conrad has seen the benefits of advance directives and how they have helped families in a time of crisis. He’s also seen the uncertainty families face without one.
“A lot of people avoid setting up advance directives because they think they are giving away control of their life,” says Conrad. “It’s just the opposite—having an advance directive preserves your decision making when it comes to medical care, even when you can’t communicate and be actively involved. An advance directive can provide direction and reassurance during a very chaotic time.”
Conrad says creating an advance directive encourages having thoughtful discussions with loved ones before a crisis. “When I work with families in an ICU, many of them say they don’t know what the patient wants in his or her medical care. With changing family dynamics, this can make a tough decision even more challenging.”
Two types of advance directives—the durable power of attorney for health care and the living will—are legally recognized in Iowa. Durable power of attorney allows you to appoint someone to make medical decisions for you if you can’t. Usually this person is a spouse, an adult child, or a friend who acts as an agent for you. The agent has your permission and authority to carry out your health care wishes. These wishes are typically written in the durable power of attorney document; however, they can also be verbally shared. If there is any confusion about your desired care, your agent has the power to make decisions he or she believes are in your best interest. To create a durable power of attorney document, you don’t need a lawyer, but you must be at least 18 years old. The document needs to be signed and witnessed or notarized to be legal.
The living will directs the physician to withhold or stop treatments that will only prolong the dying process. The actions of a living will are carried out when a patient can’t make health decisions and two physicians agree that death will happen soon. A living will gives the doctor your direction when it comes to machines, drugs, and/or treatments that prolong life. A living will is important if you don’t have a durable power of attorney or an agent or if your agent is unavailable.
Deciding whether to have one or both advance directives is entirely up to you. The advantage of having both documents in effect is that it gives the best picture of what your complete wishes are. Either document can be changed or canceled at any time.
Copies of completed advance directives should be shared with family and health care providers. It’s important that people you love know this document exists so your wishes can be carried out. It’s a good idea to have the documents with you or in your medical file for all hospital admissions. Carrying advance directive pocket cards in your purse or wallet is also a good idea, especially in an emergency.
Advance directives from Iowa are presumed to be valid in other states, but checking other states’ laws is a good idea. Definitions of family members and spousal relationships can also vary.
To explore creating an advance directive, a special publication, The Gift of Peace of Mind: For Yourself, For Your Family, is available. This publication answers questions and has tools to develop your plan. Mercy chaplains can answer questions, notarize these documents, and enact them. Forms and information are also available online from the Iowa Department on Aging (Aging.Iowa.gov/faq/legal.html) or from the Iowa Bar Association (IABar.net. click “Publications” and then “Brochures”).
“Creating an advance directive is easy to do, and it can be done in minutes,” says Conrad. “You can show your love for your family by getting an advance directive in place now.”