After enduring the pandemic over the past two years, we can probably agree that life is unpredictable and precious. As a hospital chaplain providing care for people facing challenging health conditions, I have witnessed the importance of people having an Advance Care Plan/Advance Directive/Living Will in place. No matter one’s age, this document ensures that the care team knows who the unconscious patient trusts to make decisions on their behalf.
An Advance Care Plan (ACP) assures that your most trusted person is the person speaking for you if you cannot speak for yourself. Whether a health crisis causes one to be unconscious for some time; or a severe health crisis leading to the end of life, an ACP informs your medical team and family of your healthcare wishes.
It allows you to choose the care you would want based on your values, beliefs and desires, according to your definition of quality of life. For instance, if you lived a good, long life and did not want to be kept alive indefinitely by machines and artificial devices, you could put that in your ACP. With advances in medical technology, people can be kept alive on machines for quite some time at great emotional pain for their loved ones, perhaps with undue physical and spiritual suffering and much financial expense.
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Who knows you well enough, and who do you trust to make complex medical decisions? In Virginia, one’s spouse is automatically appointed decision-maker without an ACP. Suppose you are separated from your spouse but without legal papers. In that case, your spouse retains the legal authority to make decisions for you. If you are not married but have a life partner, Virginia does not recognize common-law marriage. This leads to situations where the one who knows and loves you best is left without legal authority to make decisions for you.
If one is not married and has adult children (older than 18), those children are asked to step in to make decisions. I witness situations where young adults are asked to make weighty end-of-life decisions for parents when they lack the knowledge, maturity and life experiences to make such complex decisions. To consider quality of life versus quantity of life at such a young age is unfair. Having an ACP in place would be a gift to your family in such a situation.
Sometimes there is confusion between a Durable Do Not Resuscitate (DDNR) document and an ACP.
A DDNR basically says, “If my heart stops and I am dead, allow me to die without intervening — do not try to restart my heartbeat.”
The ACP applies to situations when your body is not responding to medical interventions and is continuing to decline despite the best efforts of your medical team. The ACP would guide your care in two scenarios — you are lingering and not getting better with intensive medical care, or your body is dying and medical interventions fail to turn things around. Both situations are dire and would involve conversations between your medical team and your loved ones.
Having an ACP guides the care so that your family is not having to guess, “What would Mom or Dad want in this situation?” It would already be decided by you, and your family would know what you want. When people are up against such decisions, and there is no ACP, families talk of “pulling the plug” as if the weight of this awful decision is on their shoulders. When someone’s wishes are in writing, there is no guessing. It lessens the emotional angst and guilt that families experience during one of life’s most stressful times.
Sentara Martha Jefferson makes it easy for you to complete your ACP by providing online forms to download. Our chaplains and palliative care team can assist you, and your medical provider can help you complete ACP forms. The Central Virginia Advance Directives Collaborative (cv-adc.com/resources) provides resources to guide you in planning and completing your ACP. In Virginia, you do not need a lawyer to complete your ACP; however, you need two witnesses to your signature.
Once you complete your ACP, submit it to the medical records department of your local hospital and give a copy to your primary care physician. Also, provide copies to the people you designate as your trusted spokespersons; but first, make sure to have a conversation with these people to make sure they understand your wishes and promise to uphold and respect them on your behalf.
Honor your life by putting your healthcare wishes in writing as we celebrate National Healthcare Decisions Day on Saturday. Call (434) 654-8407 to schedule an appointment if you need assistance completing your form.