It’s the conversation no one looks forward to having, but making an advance care directive makes life easier for the people you love, and can give you a sense of control and peace of mind.
The Rev. Ruth Anne Sawyer, the lead chaplain, decedent affairs coordinator and ethics consultant at Sentara Northern Virginia Medical Center, calls an advance care plan “your words when you can no longer speak.”
An advance care directive lists who you want to make medical decisions for you when you can’t. It also details what kind of treatments and procedures you want and don’t want when you’re very ill. It’s a document your loved ones can consult to make sure that phase of life goes the way you want it to. And if you wait until you know you need to have the conversation, she says, it’s usually too late to actually have it.
“It’s very empowering to make those decisions about your own life, before somebody else possibly makes them for you,” Sawyer says. And when you’re near the end of life, she adds, your family is “going to be wracked with grief. This way, they’re not going to be wracked with guilt as well, because they will be fulfilling your wishes.”
Sawyer says there’s a popular misconception that only very old or very sick people need to make advance care plans. But it can and should be done at any time, and an advance care directive can change based on your condition — a hale and hearty 40-year-old may want more intervention than they would 50 years later, for example.
It’s a one-page online form. Sawyer says she’s happy to send one to anyone who wants one, and she can come to speak to groups and hand them out. “And it’s free. And once you do it, you do it. It’s in the [U.S. Living Will] system and you forget about it.”
It can seem like a lot to contend with at first, but Sawyer recommends starting with your thoughts on what kind of care — resuscitations, feeding tubes, other treatments — you wouldn’t want to deal with.
Without a directive, the hierarchy of who makes decisions when you can’t in Virginia starts with your legal spouse — including an ex-spouse if your divorce isn’t finalized. Next, would be any children you may have, all of whom would have an equal say. Then come your parents, if they’re still alive; after that are your siblings, all of whom get an equal say. After that, any other blood relatives — uncles, aunts, cousins — would have a say.
“And the bottom would be friends that could possibly be appointed through a patient care consulting committee through the hospital,” Sawyer says. If that doesn’t sound like the ideal setup, you need to create your own list of people to make the decisions.
The form allows you to choose your primary and your secondary health care agent. “Sometimes it can be a good friend,” Sawyer says. “Sometimes it can be a neighbor. Sometimes it can be someone that has no possible emotional attachment to you, because they would be more inclined to fulfill your wishes than someone that loved you and wanted maybe to keep you for a while.”
She adds that it’s important to ensure the agents you pick know that you’ve picked them; you don’t want them to find out in a surprise phone call.
“When I preach funerals, I say, ‘There’s nothing more certain in life than death, and yet there’s nothing more uncertain in life than the time of death.’ And so being prepared for the inevitable, making decisions for your own life, is very empowering.”
Your family has their own lives and decisions to make, “but this is yours.” Being badly injured or very ill can lead to “a situation that’s completely out of control,” Sawyer says. “Sometimes this is the one thing that you can control. And I can’t control if I’m going to get better; I can’t control my situation. But I can control how I want it to end.”
Feature image, stock.adobe.com
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