Take the Time to Write Your Healthcare Decisions

By Julie Miller, BSN, RN, CCRN-K Apr 06, 2021

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“Do you have an advance directive such as a living will or a durable power of attorney?”

“Do you have an advance directive such as a living will or a durable power of attorney?” the nurse asked my husband. A question I have uttered a thousand times or more in my nursing career. I sat on the other side of the bed, the wife of a patient who needed urgent six-vessel bypass surgery, wondering why we never took the time to complete the advance care planning we know is so vital to ensuring our healthcare wishes are known.

Two years ago I started thinking about advance care planning when a colleague published an opinion piece: “I’m an ICU nurse. I know I need an end-of-life directive. So why can’t I bring myself to write it?” I thought, “Yes, I need to get started on my healthcare decisions.” Yet I still had not taken the time to do it when my husband faced his health crisis. I discovered I was not alone. More than 70% of Americans do not have a living will, the document that outlines the procedures and treatments they want and under what conditions.

With the pandemic, many of us have also seen an immense need to share our healthcare wishes with our families and other loved ones. April 16 marks the annual National Healthcare Decisions Day, an opportunity to focus on completing an advance directive to ensure our wishes for the management of our healthcare are documented.

So what does that mean and what forms should I complete?

There are two types of advance directives, a living will and a health care power of attorney (HCPOA).

I am very familiar with the HCPOA (also known as a medical power of attorney, proxy or surrogate), having served as HCPOA for my mom in her later years. It was a gift she gave me to speak on her behalf to help her manage her healthcare decisions, when she was unable to make a decision. It also helped her healthcare team become comfortable speaking to me when she was sometimes confused about her care. The HCPOA goes into effect any time you are unable to make healthcare decisions for yourself and your doctor declares you are unable to understand the consequences of your own decisions, not just at end-of-life. The living will outlines your desires for treatments and interventions at end-of-life, and specifies under which circumstances they would be acceptable. It only goes into effect if you are unable to make decisions for yourself, and you are terminal or have an irreversible condition. For example, if I am having an elective procedure and my heart stops, I definitely want them to perform resuscitation measures. However, if I am terminally ill with no hope of recovery, I certainly do not want advanced resuscitation, but I might want nutrition and hydration as part of my comfort measures. These are just a few examples of healthcare situations to consider including in a living will.

So take some time and consider what you want in different healthcare situations. The next step is to write it down!

Where can I find resources to help me do this?

The National Hospice and Palliative Care Organization (NHPCO) provides state-specific information about advance directives. NHPCO also offers CaringInfo, which provides free resources to assist with planning and making decisions about palliative and end-of-life care. Resources for caregivers are also provided. NHPCO recommends people complete their planning before they are forced to do so during a healthcare crisis. Thankfully, my husband’s crisis with bypass surgery was successful and he is well on his way to recovery.

I have more information now to help me start the planning process. I want to get this done before my husband or I have another health crisis. I’m committing to making my healthcare decisions, and since I’ll be visiting with my family soon I’m also committed to encouraging them to write their healthcare decision plans too.

What is your plan to get started on your advance directive?