Advance Directives Give You Control

Mr. Randall stood by his wife’s bed and watched.  She had been in a persistent vegetative state for weeks, but he had been unable to accept her condition.  Her doctor did his best to explain, but love and hope overruled.  On occasion, Mr. Randall talked about taking his wife off life-sustaining equipment.  Once he asked that I notify her physician, but by the time Dr. Speer arrived, Mr. Randall had changed his mind.  He simply could not get peace about what to do.  For five months this went on:  the faithful husband visiting almost daily and experiencing a roller coaster of emotions.  Then one day it was over; her body finally gave up.

I knew many situations like the Randall’s.  Some scenarios included family conflict.  A spouse decided to remove life support and the children took issue with it.  Anger would take over, bitter words would be spoken, and grief was added to grief.  It happened with the Randalls.  By the end, the children were no longer speaking with their father and had long since stopped visiting their mother.

There is a way that much of this kind of distress can be avoided, and that is by the use of advance directives.  Advance directives advise your physician of what you want when you are no longer able to speak for yourself and you can only be kept alive through artificial means.  In Tennessee, those forms are called (1) the Advance Care Plan, more commonly known as the Living Will, and (2) the Appointment of Health Care Agent, earlier known as the Durable Power of Attorney for Health Care or the Medical Power of Attorney.  The Living Will gives clear direction on how you want decisions made for you.  There are sections where you can be very specific with what you do and do not want.  The second form provides authority to someone of your choosing to make decisions for you.  You can download these forms, free of charge, at http://health.state.tn.us/AdvanceDirectives/index.htm.

In September 2011, my husband had a stroke.  It was massive, and he deteriorated quickly.  When I was asked if he had a Living Will and I answered yes, the nurse gave me thumbs up.  During a very unexpected and difficult time, I didn’t have to wonder about what Richard would want—he had put it in writing.

My husband and I had taken time years back to discuss what we wanted for ourselves in the way of end-of-life decisions.  We each had experiences to draw on to help us make our decisions and that was unquestionably a huge assist.  Neither of us wanted to be held on through artificial means, nor did we want a decision made for us by the other when a time was tumultuous and emotional.  We signed our directives, called our children and talked with them about our wishes, then mailed them copies.

Having Richard’s decision in writing didn’t make my implementation of his Living Will easy, but it did take away any concern about what he wanted.  The whole purpose of what he had done was to ensure that his last wishes were carried out as he desired when he could no longer speak for himself.  He trusted me to stand firm, and he backed the Living Will up with the Medical Power of Attorney, naming me as proxy.

I encourage others to take time to do what we did.  Have a discussion with your physician.  Ask him or her to explain how physicians come to decisions about end-of-life and probable outcome.  Ask what kinds of things might be done and what purpose they serve.  Ask every question you have so that you can make an informed decision with a calm and clear mind.  You may also want to discuss it with a clergy member of your faith.

After you’ve made your decision, do the next important thing and talk to family members—at least your children.  The most prevailing argument I heard between children and parent was that the children had never heard their mother or father say what they wanted, and, therefore, they questioned the decision one parent was now making for the other.   It can tear families apart. I saw it happen too many times.

(Other than my husband’s, names have been changed.)