Just when you thought you’d met your most important deadline for April 16, I’m here to tell you about another one: National Healthcare Decisions Day, or NHDD. NHDD is an annual initiative to encourage us all to consider, document, and communicate our wishes regarding our healthcare, that is, to do advance care planning and prepare advance directives.
You’ve probably heard about these topics somewhere. You may realize you should document your wishes, but just haven’t gotten around to doing so. Why not? If you are young and healthy, do you not see the urgency? Are you fearful of alienating other family members if you choose one as your healthcare agent? Are you concerned you will upset your family if you broach the topic of medical crises? Are you simply overwhelmed by the decisions you must make? Finally, are you just mystified as to what to do first?
Having worked with many patients and families on advance care planning during my time at Gilchrist, I’d like to offer some advice to help you overcome these obstacles.
First, choose a healthcare agent.
Choosing an agent is the critical first step in advance care planning. Designating an agent ensures that someone who knows you best is authorized to make decisions on your behalf if you are unable to do so.
This step is essential whether you are young and healthy or are living with a chronic illness. As Nathan Kottkamp, founder of NHDD, aptly points out: “…the three most famous cases regarding healthcare decision-making involved women in their twenties: Karen Ann Quinlan, Nancy Cruzan, and Terri Schaivo.” (See Wikipedia to learn more about their stories.) Their tragic medical events were marked by chaos, family conflict, and/or interference by third parties who did not know them or their wishes.
Choosing an agent is critical even if you have not yet determined what your wishes might be. An agent has the authority to make any and all decisions for you even if you have not specified your wishes in advance.
If you are reluctant to designate a healthcare agent out of fear of offending loved ones you did not select, consider that there are many other meaningful ways to involve loved ones on your caregiving team should you become ill, such as:
- Managing communication with family and friends about your situation
- Managing legal documents and medical bills and records
- Coordinating caregivers
Your agent should be the individual who is willing and able to make decisions for you that reflect your wishes, so you should not compromise on this choice. Assign different roles to other family members based on their talents and experience and encourage them to work collaboratively as members of your team.
Second, learn more about any chronic illnesses you have.
If you are living with a chronic illness, take the opportunity before a crisis to read and ask your physician some questions about your possible disease course. Doing so will help you inform yourself and your agent about the kinds of medical decisions you may face in the future. You then can begin to consider your preferences free of the pressures of a medical crisis.
Third, work on your advance care plans each NHDD.
Advance care planning is not a one-time activity. It is a skill that we all can improve with practice. Resolve to use NHDD as an opportunity to tackle just one aspect of your advance care plans. By working even just a little bit on your plans each year, you will refine your thinking and can prepare yourself and your agent to make the right medical decisions when it really counts.
In taking on this work, you will be rewarded with: skills and experience in medical decision-making; care that is consistent with your goals and values; and a family that is unified in its purpose and ready to collaborate during your time of illness.
Set an example for your children and/or your friends. Get started on your advance care plans by designating your healthcare agent on April 16.
Anthony Riley, M.D.
Gilchrist Chief Medical Officer