Advance directives: Who decides for you?

I come from parents who were conservative Yankees. They lived through the Depression and World War II being cautious with their money – including how they died. Our dad’s ashes were buried in a Chock Full o’ Nuts coffee can and my mother’s were in her favorite cookie jar. They were frugal except with their sense of humor. Both wanted no extraordinary measures or costs at the end of their lives as well as simple, joyful celebrations in their memory. Why do I tell this tale?

End of life costs are staggering. CBS News reported that in 2008, “Medicare paid $50 billion just for doctor and hospital bills during the last two months of patients’ lives – that’s more than the budget of the Department of Homeland Security or the Department of Education.” The president of Maine Health, Bill Caron, recently told members of the Portland Community Chamber of Commerce that advance directives are one significant solution to the high cost of the nation’s health care. What is an advanced directive and why do we need it?

As a society, we’re not very good at discussing death (except in LaCrosse, Wisconsin which boasts 96% of the population having an AD). An advance directive gives guidance as to how we wish to die. It also removes the mystery and burden of our decisions for those we love. Go online to find a form applicable to your state. Here’s a synopsis of the Maine Hospital Association’s advance directive.

• First, you need to give someone the Power of Attorney for health decisions. His/her role as your agent will be to make decisions that are consistent with your wishes and the circumstances of your condition.
• Tests, medication, surgery
• Whether or not to prolong your life through intravenous fluids, respirators or other mechanical means
• Whether or not to be resuscitated should you stop breathing
• Where you wish to be in your remaining days such as home, hospice facility, hospital or nursing home
• You can designate a second and third person if your agent is unable or unwilling to make the decisions you have directed him or her to make on your behalf.
• You also can choose to let your agent start making decisions immediately regarding your health care or you can require that your physician or a judge must first agree that you are incapable of directing your own care before your agent assumes responsibility.
• You also should decide if you want to be kept alive within the limits of accepted medical practice or that you simply wish to die without intervention if you are terminally ill or are in a vegetative state and unlikely to regain consciousness.
• You should indicate if you want pain medications that could cause your decision making to be difficult and/or could hasten your death.
• You can decide whether or not to donate organs and tissue for transplants upon your death or donate your remains to scientific study.
• Finally, you should indicate how you wish to be buried and how your life should be celebrated.

While most Americans wish to die at home, about 75 percent die in a hospital or nursing facility. At an estimated cost of $10,000 per day for care in an intensive care unit (ICU), far too many people and families endure anxiety, indignities and high costs. Even if you’re perfectly healthy, you can make an advance directive and change it at any time.

Talk with your physician, spouse and family knowing you’ll be taking charge of your final chapter.