Necessary conversations about advanced directives

Most likely you’ve been able to successfully put off completing these up until now. But 15 minutes from now, you’ll feel a sense of urgency that you haven’t felt before. Why? Because you love your family.

Trust me, you’ve never heard a compelling reason like these before. As a bonus, the way we’ll show you to get it done is easier and more thorough than it has ever been.

An advanced directive is a group of legal documents called springing documents that spring forward to sometime in the future that imagine some future condition.

In this case, a health condition such as a terminal or irreversible illness. These documents allow you to say in advance what kinds of treatment you would desire and who you want to make decisions for you if you can’t speak for yourself.

When we think about being terminally or irreversibly ill, it doesn’t usually seem pleasant. In reality, it’s pretty serious. Which leads to some of the reasons why people choose to put off doing them.

Here are some of the reasons we procrastinate:

  • “I’m young, I don’t need one.”
  • “I’m not sick. Only sick people need them.”
  • “I just don’t slow down enough to get them done. There are more pressing things I need to do.”
  • “It’s a Do Not Resuscitate Order (it isn’t). If I fill one out, they won’t treat me (they will).”
  • “They don’t work, right?”
  • And the biggest of all the reasons, “I really don’t want to think about it.”

Only you know which one is your reason. It may be several of them. Until now, the reasons above may have been good enough; that was up until now.

There have been problems with advance directives. Some have even argued that they should be scrapped.[1]

When advance directives fail, and they do, it’s often the result of poor communication: either our family or doctors don’t know our wishes or they don’t have copies of our documents, or they aren’t current. Sometimes, patients are outside of the document’s jurisdiction. The recommendations I make later can help with that.

In 2011, researchers David Wendler and Annette Rid examined 40 studies looking at 2,854 people who had to make the choice to remove life support on a loved one.[2] Wendler and Rid put together all the data from the 40 studies and asked the question: How did the decision-makers do after they made the choice?

So, how did they do? Not well.

If you have to make hard choices for a loved one, the effects are often long and severe, lasting months or years. It is often, in short, devastating. The guilt and stress may even result in mental health issues such as Post-Traumatic Stress Disorder (PTSD).

But, there were things that helped ease the guilt somewhat: knowing what their loved one would have wanted and having an advance directive on hand to guide them. These did not take the pain away: nothing could do that. However, in most reviews they did add a measure of solace that loved ones made the right decisions.

Which leads to the question: If it’s clear that having an advance directive and sharing our choices can help our loved ones, why wait? Can you imagine having to live with that kind of choice with no guidance?

Recently, Baylor Health Care System has been encouraging people to use a new online tool to complete these documents, MyDirectives.com.

Since 2005, I’ve helped somewhere in the neighborhood of 35-100 people a month complete these documents and have always enjoyed helping folks with the written versions. I was a little skeptical of this fancy new online version.

But a couple of months ago, I asked myself, Could the online version fix some of the problems that we’ve had with advance directives? Time for an experiment: I’ll redo my own using this fancy new tool.

Two hours later, my wife got an automatic email informing her that I had done my directives and that I had shared them with her. She immediately calls me: “Are you okay? Is something wrong?”

In hindsight, I probably should have told her to expect this. A few days later, I walked a patient through the process. It was one of the most meaningful visits ever. Since that time, even if I help the patient with the state statute forms, I encourage them to go home and do MyDirectives.

The typical state-created advance directive template is terribly cut and dried: These are the basics of what I want, don’t want, and who makes decisions for me. The MyDirectives version does all that and far more.

What things are most important in your care? Who do you want around you if you aren’t able to speak for yourself? Who don’t you want around you? What kinds of things about care are most important? What makes you laugh? Where do you want to spend your final days? What are your religious preferences, if any? What are your hopes and fears? You can speak to all these things and many more using this tool. You can also upload videos to the site as you go through the questions.

Remember when I mentioned the problems with advance directives? Communication was one of them. This tool allows you to share your documents with other people including your decision makers and physicians. It’s always easy to update and always available.

You don’t have to go through some big process or meet with a lawyer to update them. They’re always fresh.

We want the best for the people we love. We want to make things as easy as possible for them. Creating an advance directive, a meaningful one, is the caring thing to do. If the research above is any indication, these documents speak beyond the grave, sometimes far beyond. I hope mine will.

[1] Fagerlin, A. and C.E. Schneider, Enough. The failure of the living will. Hastings Cent Rep, 2004. 34(2): p. 30-42.

[2] Wendler, D. and A. Rid, Systematic review: the effect on surrogates of making treatment decisions for others. Ann Intern Med, 2011. 154(5): p. 336-46.

About the author

Mike Davis
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Mike Davis is the chaplain at the Baylor Jack and Jane Hamilton Heart and Vascular Hospital in Dallas. He received his Master of Theology from Dallas Theological Seminary and his Clinical Pastoral Education at Baylor Dallas.

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Necessary conversations about advanced directives