By Kelly Cooke, DO
As a physician who practices palliative medicine, I have many opportunities to speak with patients about their wishes for the end-of-life. I use these conversations to provide information needed to make thoughtful and objective advance health care decisions.
Even though advance health care planning is particularly important in crisis situations, a health care directive is most often activated after a patient has become progressively more ill over a long period of time. The Dartmouth Atlas of Health Care has found that more than 90 million Americans have at least one chronic illness, and 70 percent die from a chronic illness. For patients on Medicare, nine in 10 deaths are associated with chronic diseases, according to the Dartmouth research.
Planning ahead relieves your loved ones from wondering, “What would Mom want?” By thinking about your advance health care choices, you can consider what measures you would prefer to be taken if your quality of life declined and could not be improved. What do you want that time to look like? What kind of health care do you envision for yourself?
Start the conversation
People often think about advance care planning as documenting end-of-life care decisions in a health care directive and naming a health care agent. In reality, the directive and agent support your conversations and decisions, rather than the opposite. Advance care planning is a comprehensive process. Conversations about your wishes are as important as documenting them. These conversations also help to cushion an emotional experience for your family.
Talking about end-of-life care with loved ones allows you to explain why your choices are important to you. While no one looks forward to these conversations, if you have learned about or done some advance care planning, talking about end-of-life care can become as natural as discussing long-term care insurance. You can even tell family members that, like insurance, you hope your directive never has to be activated, but it’s a relief for you to have it if it’s ever needed.
Consider your goals
As you continue to think and talk about your future health care, you will most likely shape your own wishes for end-of-life care, and these goals can evolve over time. Many patients have told me that their goals for advance care planning are to:
Ensure that they can spend quality time with family members at the end of their lives, rather than having family spend time making health care decisions.
Relieve family members of undue distress, responsibility, burden or guilt for making health care decisions about them.
Define for themselves what terms such as “life support” mean.
Explain their choices to loved ones.
Eliminate or reduce the potential for differing family viewpoints about their care.
Make — and, importantly, change as many times as they wish to — end-of-life health care decisions themselves.
Choose your legal advocate
There is an essential reason for Wisconsin residents to make advance health care decisions and name a health care agent: Wisconsin is not a “next-of-kin” state. If you were unable to speak for yourself, the person you would prefer to speak for you may not have the legal authority to do so. In Wisconsin, if you don’t have a designated health care agent, your family may end up in court when your health is at its worst. A court case could be very costly, possibly draining the estate you envisioned for loved ones. And worse, the court could appoint a legal guardian for you that you and your loved ones would never have chosen.
Remember, your health care directive comes into play only if you cannot understand health care information being presented to you and make decisions about your own care. It is not used in any other scenario, and is not even available for anyone to see unless you show it to them. It is filed with your physician, and you can carry a card in your wallet to alert others of its existence.
Information about advance care planning, including questions and answers, a glossary of legal terms, power of attorney forms, and many other resources are available at no charge at ProHealthCare.org/AdvanceDirectives. To speak to a ProHealth Care professional about advance care planning, call 262-928-2450.
A Wisconsin Medical Society video about advance care planning can be accessed at WisconsinMedicalSociety.org/Professional/hcw/.
ProHealth Care offers classes in advance care planning. Visit ProHealthCare.org/Classes to check the class schedule and register.
Kelly Cooke, DO, is a physician specializing in palliative medicine for ProHealth Medical Group and works at ProHealth Waukesha Memorial Hospital and ProHealth Oconomowoc Memorial Hospital. She is a doctor of osteopathic medicine and is board-certified in medical oncology and palliative medicine.
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For more than a century, ProHealth Care has been the health care leader in Waukesha County and surrounding areas, providing outstanding care across a full spectrum of services. The people of ProHealth Care strive to continuously improve the health and well-being of the community by combining skill, compassion and innovation. The ProHealth family includes ProHealth Waukesha Memorial Hospital, ProHealth Oconomowoc Memorial Hospital, ProHealth Rehabilitation Hospital of Wisconsin, ProHealth Medical Group, the UW Cancer Center at ProHealth Care, Moreland Surgery Center, ProHealth AngelsGrace Hospice, ProHealth Home Care, ProHealth West Wood Health & Fitness Center and ProHealth Regency Senior Communities. Learn more at ProHealthCare.org.