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Thinking Ahead: The Importance of Advanced Directives

Updated: Nov 24, 2023


A hand is holding a document and a woman is seated in the background.  You can only see her elbow, waist and thigh.

Advanced directives play a crucial role in healthcare planning, yet they are often overlooked. An advanced directive is a legal document that allows you to express your medical care preferences in the event you cannot communicate them yourself. Having clear advanced directives provides essential guidance to healthcare providers and peace of mind for you and your loved ones in the face of serious illness or injury.


Decide What You Want

Advanced directives allow you to specify whether you want interventions like CPR, breathing tubes, feeding tubes, dialysis, and more if you have a terminal diagnosis or are in a vegetative state. You can also designate someone to make medical decisions on your behalf if you become incapacitated. Thinking through your values and priorities will help guide these decisions.


Choose Your Health Care Power of Attorney Wisely

Your health care power of attorney (or health care proxy) is the person you designate to make medical decisions if you cannot. Choose someone who knows you well, shares your values, and is capable of handling the responsibility of making health care decisions. Select a level-headed person who can advocate for your wishes.


Be as Specific as Possible

While you can keep your advanced directive general, providing more specifics gives better direction to your care team. In a recent interview on the Beyond the Paper Gown podcast, Dr. Monique Nugent, a hospitalist and author of "Prescription for Admission," underscored the significance of advanced directives. As a hospitalist who cares for acutely ill patients, Dr. Nugent witnesses firsthand the challenges that arise when a patient's care preferences are unknown.


Dr. Nugent notes that detailed information reduces ambiguity and helps your healthcare proxy carry out your wishes. "The more information you can put into your Advanced Directive, the better," she said. "People get really specific. I've seen people say things like, 'If after two weeks, I cannot come off the ventilator. I want x,y,z done.' Your advanced directive is a document meant to speak for you if you cannot. Giving your loved ones the gift of detailed information in your directive allows them to act on your behalf as best they can, which relieves tension and guilt for them in following your directions."


Review Regularly

Revisit your advanced directive after major life events to ensure it still aligns with your priorities. Update it as needed, as perspectives can change over time.


Give Copies to Key People

Provide copies of your advanced directive to your primary care doctor, hospital, health care proxy, and close family members so that it is accessible when needed.


Have Important Conversations Now

Creating an advanced directive requires asking yourself difficult but crucial questions, such as "What is your code status?" As Dr. Nugent explains, "Your code status is what you have decided you would want done for you in the case of an emergency, if your heart stopped beating or you stopped breathing." While this may seem morbid to think about when you are well, she stresses that "it's to respect your wishes in the case of something like that occurring." Having clear advanced directives helps ensure your care aligns with your values if the unthinkable happens.


Make Decisions Before a Crisis

Advanced directives are deeply personal decisions rooted in your values. According to Dr. Nugent, they are "never really made in a vacuum. Oftentimes, people often talk to their loved ones, whoever helps them make decisions, who they live with, who cares for them." She advises having conversations about your priorities and preferences early, before facing a crisis: "The best time to make these decisions is when you don't have to. Because if I'm looking at you and I'm saying we need to make this decision now, chances are, we're in a situation where it's a little too late to have a thoughtful and full conversation."


Creating thoughtfully crafted advanced directives gives you more control over your care when you need it most. Although end-of-life planning may seem daunting, Dr. Nugent emphasizes that the best time to make these decisions is when you are not in an urgent situation.


So, take steps today to document your healthcare preferences and priorities. Doing so will provide you and your care team with invaluable guidance and much-needed peace of mind.


For more expert insights on navigating the healthcare system, listen to the full interview with Dr. Monique Nugent on the Beyond the Paper Gown podcast.



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