Do Your Family a Favor: Create Your Advance Directive for Healthcare

By Robin Lacrimosa

During my long and varied career working with older adults, I spend about 14 years as a social worker in the emergency room at one of the hospitals in Athens. One of my tasks was to work with families who were dealing with the death, either sudden or impending, of a family member. My job was to be with the family from the time the patient came in and we recognized that the patient probably wouldn’t survive their ER visit until the time they left the emergency room after the person had passed away.

I saw a lot during those years. Many people came to the emergency room as the result of a traumatic event like a car wreck or a heart attack. The experiences that stand out are the ones where the family members had no idea what kind of lifesaving treatment the patient wanted. In many cases, those family members had to make difficult decisions under pressure. Not everyone agreed about what should be done. Conflicts were common.

These conflicts are totally avoidable, and the only way to avoid them is to have an advance directive that explains what you do and don’t want in the way of medical treatment. How much should the doctors do to save you? Unless you want to put your family through the wringer, this is a question you need to answer in advance. Yet, according to a 2017 meta-analysis by HealthAffairs.org, among the 795,909 people in the 150 studies analyzed, only 36.7 percent had completed an advance directive. That’s around one in three people.

Take CPR, for instance. If your heart stops, do you want CPR? Most people don't realize is how traumatic CPR is. I had an instructor tell me, "If you don't break ribs, you're not doing it right. You're not doing it hard enough." Imagine that you’re an older, frail adult whose heart stops and you receive CPR. It’s likely that your ribs and your sternum will snap like twigs as the CPR is being administered. Is that kind of trauma necessary just to keep you alive? And if the doctors manage to keep your body alive, will you be able to function at the level you once did? The answer is usually no.

Questions like “Do you want CPR in the event of a cardiac arrest?” and “What extraordinary measures do I want to prolong my life?” need to be asked long before the medical event happens, and the answers need to be documented in an advance directive. This makes it far more likely that your wishes will be followed in the event of a medical event. Even more important, it takes the pressure off of your family members to make those tough decisions without knowing your wishes. Instead of arguing about what type of treatment you should receive, your family members can be present in the moment to focus on quality time together at the end of your life, confident that they’re honoring your wishes. That’s the best gift of all.