BY GEORGE FJELD, M.D.
Are you concerned about what happens to you medically if you can’t think, speak or communicate? Have you had to make decisions about healthcare for a friend or loved one when they can’t answer for themselves? These two scenarios are unfortunately common and very difficult personally and emotionally. Most of us don’t live our daily lives thinking about catastrophic events like strokes, heart attacks, and life-threatening accidents; we avoid them. When these events do happen, it is a great relief to have prepared a statement of your intentions for medical decisions. Being on either side of this situation, whether it’s you lying in a hospital bed unable to speak/hear or you standing at the bedside concerned about your loved one, decision making is very difficult. Life and death, quality of life, concerns about personal care (unable to perform personal hygiene), and the need for long term nursing care all come up in these conversations. Knowing the intentions of the person unable to communicate helps decision making tremendously.
Fortunately, there is a law providing the ability to create and register an Advance Directive, also known as a living will. This document can be completed in writing or online, without legal assistance. There is a guide with the document available. Completing it will enable you to designate a healthcare agent and substitute. These are the people with whom your healthcare team will discuss your situation. It is important to talk with your agent about your wishes so they have a clear idea about what you would like in a critical situation. These are emotional discussions and should be approached with a lot of care. Be sure your agent understands your wishes and is willing to carry them out.
Some people, depending on health or life expectancy, ask their healthcare provider to fill out a Do Not Resuscitate (DNR) or Clinician Order for Life-Sustaining Treatment (COLST). These documents can allow withholding of CPR or other emergency care by first responders or rescue personnel when the individual and their provider have decided it will not benefit the individual. People with these orders in place can wear a necklace or bracelet declaring their wishes. These directives require in-depth discussion with your healthcare provider.
Anyone may complete an Advance Directive. Marion Bouchard, M.D. from Bristol, VT once told me “The only people who need an Advance Directive are those who don’t have them.” While this isn’t completely true, having one is the best way to ensure your wishes are carried out. The State of Vermont has a website where the Advance Directive can be registered so that it is available at every hospital in the state. Copies should be shared with family and caregivers. Please consult with your healthcare provider for more information.
