Health

Pass the Turkey — and Let’s Talk About the Future

Here are some of the toughest yet most vital conversations to have over the holidays while everyone's together

Less than half of all American adults have communicated their wishes to their family and loved ones for their end-of-life care. You may assume it’s all about denial, but research consistently shows it’s more often a lack of needed information — because no one ever brought it up.

With everyone gathered at the Thanksgiving table on Thursday and beyond — sharing meals all weekend long — you’ll likely be surrounded by the most important people in your life. These are the folks who will be with you at the end; you will need them.

There’s no question loved ones should hear what you have to say on the subject. There are three really good reasons, actually, why Advance Care Planning deserves to be checked off your to-do list — and the holidays just might be the time to get that done.

This is not your grandmother’s or even your mother’s end-of-life care.
Palliative care, do not resuscitate (DNR) orders, assisted oral feeding, polypharmacy — for all of these, are the physician, patient, and proxy all speaking the same language? Advance Care Planning is about becoming familiar with medical terminology and life-extending options, then making considered choices ahead of time. An advance directive is the written record of your plan, intended to preserve your right to informed consent, whether exercised by you or your proxy in the future.

There are two types of directives. A living will is a set of instructions, while a durable power of attorney for health care is the appointment of a proxy to carry these wishes out, if need be. (Those two legal documents can also be merged into one, called a combination directive.)

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You can’t anticipate every scenario, but you can plan. 
Your health care advance directive should cover specifics for the use of life-prolonging measures, such as a ventilator or a feeding tube. But a directive should also detail the process for decision-making in any situation, whether it’s by you or your proxy. Why? Because you cannot anticipate every possible scenario — and a medical crisis is the time when most of us can use clearly defined guidance, thoughtfully prepared in advance.

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Having a functional blueprint in place will be a lasting gift for loved ones who may need to manage your care.

You’ll need a health care proxy to make the best decisions for you.
The people you choose to be your proxy and alternate proxy will be entrusted with advocating for your instructions. Start by using a legal form that details their potential duties and responsibilities so they are fully informed when they accept the appointment (seriously, you must first ask them to serve).

An open discussion of your wishes with proxies and others who may be there in a future crisis is the foundation of applying substituted judgment, if that ever becomes necessary. That means your proxy will be prepared to choose as you would choose and can clearly communicate your wishes to health care providers. That same comprehensive directive can act as an outline for the all-important conversation that begins with “Are you willing to be my proxy?”

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You could be a proxy for someone else. 
If you’ve ever had the privilege of being there for a loved one who is dying, you know where I’m going with this: Once you’ve done your own planning, you’ll be familiar with medical lingo, possible treatment options, and the job of an advocate. If the situation ever arises, you’ll be ready to assume your role as the best possible proxy for another person.

Preserving patient autonomy in our increasingly complex health care system demands Advance Care Planning that includes thoughtful consideration, clear communication, and an effective written directive.

Think of Advance Care Planning as preparing for and cleaning up after the Thanksgiving feast: At first glance, it seems like an insurmountable task. But when it’s over, you can look back at what you accomplished for the sake of yourself and your family, and proudly say, “Job well done!”

Jo Kline Cebuhar, J.D., a native of Des Moines, Iowa, is the author of two books, “The Practical Guide to Health Care Advance Directives” and “So Grows the Tree: Creating An Ethical Will.” 

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