Advanced Directives

It is very common for a family to be faced with making difficult decisions about end of life care. The palliative care service can be helpful in this situation. Palliative care services are experts at being sure the right medications are being used to provide comfort and awareness, coordinating family meetings, and discussing prognosis. They can also assist in weighing the benefits or risks of a life supporting therapy such as going on a ventilator or dialysis. Having an advanced directive that designates a surrogate decision maker is important but many do not have one when a crisis occurs. It is very common for a family to be faced with making difficult decisions about end of life care. The palliative care service can be helpful in this situation. Palliative care services are experts at being sure the right medications are being used to provide comfort and awareness, coordinating family meetings, and discussing prognosis. They can also assist in weighing the benefits or risks of a life supporting therapy such as going on a ventilator or dialysis. Having an advanced directive that designates a surrogate decision maker is important but many do not have one when a crisis occurs.

There have been amazing advances in how we manage most cancers over the past twenty years. People who would have had a very limited life expectancy in the past now are living for many years, even with later stages of cancer. We have also developed technologies that carry a heavy burden at the end of life. We can keep people alive on a variety of “machines” without really adding to their meaningful life. Many patients tell me “I want everything done to stay alive”. That is very understandable; however it must be balanced with a discussion of the other things that are important to them. Advanced directives are a way to have that discussion and avoid unnecessary suffering for patients and families. There have been amazing advances in how we manage most cancers over the past twenty years. People who would have had a very limited life expectancy in the past now are living for many years, even with later stages of cancer. We have also developed technologies that carry a heavy burden at the end of life. We can keep people alive on a variety of “machines” without really adding to their meaningful life. Many patients tell me “I want everything done to stay alive”. That is very understandable; however it must be balanced with a discussion of the other things that are important to them. Advanced directives are a way to have that discussion and avoid unnecessary suffering for patients and families.

An advance directed is often offered at the point of admission to the hospital or in a physician’s office. An individual has the option of naming a family member or friend to act as their voice should they be in a position where they are unable to communicate. Choice of care options can be communicated in writing as part of the advance directive, one can be very specific. It is also recommended that the individual has a conversation with her physician and loved ones about their specific requests. Hospital and physician will indicate the presence of the advance directive in the patient record.

Individuals with concerns about how to broach the subject of end of life care with loved ones should speak with a counselor. An advance directed is often offered at the point of admission to the hospital or in a physician’s office. An individual has the option of naming a family member or friend to act as their voice should they be in a position where they are unable to communicate. Choice of care options can be communicated in writing as part of the advance directive, one can be very specific. It is also recommended that the individual has a conversation with her physician and loved ones about their specific requests. Hospital and physician will indicate the presence of the advance directive in the patient record.

Individuals with concerns about how to broach the subject of end of life care with loved ones should speak with a counselor.