Advance Directives

I am writing to raise awareness about Advance Directives (ADs). These are legal documents that ensure your personal health care wishes, values and preferences are carried out if you can no longer speak for yourself. In Ohio, ADs include a Durable Health Care Power of Attorney, which names a trusted person you choose to be your voice if you become incapacitated, and a Living Will, which communicates your end-of-life health care and treatment choices.
I get it. No one wants to talk about the moment when they can’t talk. Admittedly, it takes courage to plan for the end of life when we still have a whole lot of living to do. It takes even more courage to talk about it when it is quickly approaching for us or someone we love.

However, I can share first-hand why there is great value in having conversations and completing ADs while loved ones are still relatively healthy. On April 14, 2020, my mother suddenly became weak, confused and unable to make decisions for herself. COVID-19 had disrupted our household for the third time. The decision I had to make was clear and unquestioned. Yes, I was stressed, but not as stressed as I would have been if I had no clue as to what my mother’s wishes were.

Fortunately, because of several conversations my mom and I had over the years, I knew exactly what she would want. She had made it clear to me, our family and her friends that she wanted to die at home with her family, not in a hospital. Because she had not only talked about her wishes but had documented them in her AD, I had no issues carrying them out. Hospice of the Western Reserve was called, and care was started the next day in our home. 
 
I share this story because, without those prior conversations, I would have been left with the burden of making decisions without really knowing what my mom wanted. During a medical emergency is not the time you want to try to figure that out.
 
If we listen carefully as we talk with our loved ones and close friends, we can hear them expressing clues. Often, you have been riding home from a funeral or memorial service, and the conversation has been riddled with comments like, “Don’t let that happen to me. I don’t want to suffer like they did. I just want to die in my sleep.” These statements are hints about how a person wants to die. In the most fundamental form, these utterances are Advance Directives.
People often say: “I want to be in charge.” If you are that type of person, then advance care planning is for you. Advance Directives put you in charge. Additionally, they empower the person you select to speak and direct medical care on your behalf with confidence, power and authority.

It may be comforting to know that once your ADs are completed, you can change them any time. In fact, they should be reviewed and updated periodically. Health care preferences change over time, and are influenced by age, health conditions, access to medical technology and life experiences. The conversations about medical preferences and end-of-life support will vary vastly depending on where you find yourself on the life span continuum.

Thankfully, my mother survived her COVID-19 medical crisis. Her condition gradually improved, and she was discharged from hospice care in July of 2020. She is now 97; we still talk about her health care wishes. She continues to express that if things change, and her health worsens, she wants HWR to provide her care. She is in control and using her voice to direct how she lives and how she will die.
 
Planning is a process that takes time and care, but it does not need to be difficult. Hospice of the Western Reserve offers a guide called “Courage in Conversation” that includes tips for having conversations, worksheets to help evaluate personal values and goals, plus all the legal documents required by the State of Ohio, including the Health Care Power of Attorney and Living Will forms. The free booklets can be downloaded at hospicewr.org/decisions.

Darcia L. Simpson, M.Div, CT, Ph.D., is an integral member of the transdisciplinary care team at Hospice of the Western Reserve. As a full-time spiritual care coordinator, she collaborates with physicians, registered nurses and social workers to assess patient and family spiritual needs, identify spiritual problems, develop goals of care and implement appropriate interventions. She is an assistant professor of Family and Community Medicine at Northeast Ohio Medical University (NEOMED), where she teaches Human Values in Medicine. In addition to her 23 years of experience in chaplaincy, spirituality and health care, Dr. Simpson is an active advocate for equal access to health care, geriatric and dementia education, hospice and end-of-life issues in Greater Cleveland.