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Adults of all ages should have advance directives

If you've checked into a hospital lately, you've been asked if you have an advance directive, a document that explains your wishes if you can't speak for yourself.

And if you're like most people, you've said no.

Especially if you're there to have a baby or minor surgery. Those directives are just for really old or really sick people, most people think.

Think again.

Fact is, if you're old enough to vote, you're old enough to need an advance directive. My 28 years as a physician, now in palliative care, have convinced me of that.

Competent adults have the right to make decisions regarding their own health care. Some people want everything possible done to keep them alive. Others would rather not.

But would your loved ones know what you would want if you were too ill or injured to express your wishes? I've seen families struggle terribly with such decisions when faced with such a crisis.

An advance directive is a legal document that allows you to document your wishes — when you're well enough to think long and hard about them.

A federal law called the Patient Self-Determination Act (PSDA) requires hospitals, nursing homes, home health agencies and most other health care institutions to ask patients, when they are admitted, if they have an advance directive.

But they are not required to help patients complete the document or help them understand all the possible outcomes of the treatments and procedures being considered.

Besides, most people are tense and anxious when they're going into the hospital, making it a tough time for major decisions. Plus, you need time to educate yourself, reflect on your values and talk with your physician and your loved ones before you fill out the form.

You can't do all that at the admissions desk when you're about to have surgery, and you certainly can't do it if you are sent to the emergency room after a car accident.

Someone there to speak for you

The most important part of the advance directive is appointing the health care surrogate. That's the person who will speak for you when you can't.

Many people choose their spouse, but be sure whomever you choose has these traits:

• Easily available to your medical team.

• Willing to honor your wishes even if they do not agree with them.

• Understands your spiritual values, cultural beliefs and your decisions about medical care.

• Understands the responsibility of being a surrogate and is willing to take it on.

Talk with the doc

A relatively new tool to capture a person's end-of-life wishes is POLST (Physician Orders for Life-Sustaining Treatment).

If you choose to, you can have your doctor complete the form after an in-depth discussion. It becomes part of your medical record.

It does not replace an advance directive. Rather, it works with it to translate those wishes into medical orders, which must be honored wherever you are being cared for. POLST can prevent unwanted or medically ineffective treatment, reduce patient and family suffering and help ensure that the patient's wishes are honored.

There are POLST programs operating in 12 states. More are being developed, including in Florida.

A living document

It's never too soon to complete an advance directive — for your sake and especially for your family.

Difficult and important decisions regarding issues like feeding tubes, intravenous fluids and cardiopulmonary resuscitation need careful thought. Based on factors like age, overall health and, most importantly, quality of life, your advance directive is highly personal and should evolve as your circumstances change. Review it when you get married or divorced, or have a child, or move or retire. All these things might (or might not) change your thinking.

When you've completed your directive, be sure to make copies for your health care surrogate, physician and your loved ones. Have a few extra copies on hand for trips to the hospital.

Properly done, advance directives can be key to helping create a culture of shared and informed decisionmaking for adults of all ages. They increase the likelihood that you'll receive the care you want and give your loved ones guidance when they desperately need it. Go out and do one!

Dr. David B. Brecher is the palliative care physician at the Mease hospitals, an associate medical director of Suncoast Hospice, and is board certified by the American Board of Hospice and Palliative Medicine.


• Project GRACE: Easy-to-download advance directives form in English and Spanish at Or call (727) 536-7364.

• Suncoast Hospice: or (727) 467-7423

• POLST: Physician Orders for Life-Sustaining Treatment:

Adults of all ages should have advance directives 05/21/10 [Last modified: Thursday, May 20, 2010 10:15pm]
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