Tough Conversations

Solutions Through Compassionate Communication.

Time to Dust Off Your Advance Medical Directive

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I seem to collect Advance Medical Directive (AMD) stories. Weird?? Yeah, I know. But bear with me for a minute of two:

A colleague recently told me about a friend who was rushed to his local hospital with a severe heart condition. The doctors asked whether he had an advance medical directive. “Yes,” he barely replied since he was sedated at the time. “Who’s your health care proxy?” his doctor then inquired. The patient gave the name of a former neighbor who had moved to a different city 10 years earlier. The doctor finally tracked down the former neighbor and asked him whether he would be available should the patient’s condition worsen.

The former neighbor asked, “Who is this?” The doctor explained that his former neighbor was in local hospital’s ICU, and the medical staff needed the name of the patient’s health care proxy.

The former neighbor could barely recall the patient, his name, or how long ago they were neighbors. Needless to state, the former neighbor told the doctor that he would not take such responsibility for a person he hardly remembered.

OK. This sounds rare. But consider whether you, your children, others in your family, and circle of friends have an AMD? Have they named a proxy whom they trust to make critical decisions if things head south? Have they discussed their wishes with that person?.

April 16 is national Health Care Decisions Day. A dedicated physician and medical ethicist* – Dr. Nathan Kottkamp — has made it his life work to ensure that we are prepared for the fateful time when we may need someone to stand-in for us if we cannot make life or death decisions for ourselves.

Following are some web-based resources for AMD’s. PLEASE look them over. Review your own AMD, if you have one. Is it current? Have you discussed its provisions and your wishes with your proxy? (Not a former neighbor but someone close to you.) Don’t let more time slip by.

www.agingwithdignity.org

www.nhdd.org

www.caringinfo.org

Sig Cohen

*Correction:  Nathan Kottkamp is an attorney, not a doctor or an ethicist.

A Living Will is Not Enough

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In previous postings we have exhorted you, dear reader, to make sure you have a living will or an advance medical directive so that your loved ones and your doctor will know what kind of care and, eventually, death you wish to have.

In the past we have referred you to Five Wishes and to the Annual Health Care Decisions Day (the next one is April 16, 2013) as important resources. But instructions and documents are not enough. The process is incomplete without a conversation with your children, your parents, spouse or anyone whom you want involved in your end of life care.

Completing an Advance Medical Directive can be a challenge. But what people often find more difficult is the conversation that needs to take place before preparing the document.

Let’s face it: Too many people are dying in ways they wouldn’t choose, and too many of their loved ones are left feeling bereaved, guilty, and uncertain.

Which brings me to The Conversation Project. Founded by the noted columnist and writer Ellen Wilson, it is a resource to guide us through the often sensitive process of discussing end of life plans with loved ones. Ellen writes that she didn’t have this conversation with her Mother before she got dementia. As a result she was faced with myriad decisions she had no way to resolve because she never had “the conversation” with her Mom.

For those of you who are unsure when and how to have the conversation with a loved one, check out www.theconversationproject.org. It features an easy-to-download guide to initiating and carrying out these talks that should make the process much easier.

Sig Cohen

PLAN FOR THE WORST

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One of the toughest conversations I’ve experienced revolved around what to do if a loved one were in a coma and I had to decide whether to continue her life support. What a responsibility: To have life or death decision-making authority for a parent or spouse or even a child.

We’ve all heard about people whose lives were artificially sustained long after they had the ability to communicate, or move, or even breathe on their own. Some remain in a comatose state on life-sustaining equipment for years because no instructions set out what treatment the patient desired.

Why have a living will or advance directive? Simply, to enable you to direct your medical care if you are unable to communicate your wishes. If you are in a serious accident or a coma, medical professionals will want to know your wishes. Without knowing them they are bound to prolong your life, however serious, life threatening, or terminal your condition may be.

Legal documents that set out your wishes go by many names: living will, durable power of attorney for health care, advance medical directive, and health care proxy.

A Living Will allows you to inform health care providers the kind of medical treatment you wish to receive or have withheld if you are too ill or injured to make an informed decision. One of the most thoughtfully written is known as “Five Wishes.” Check www.agingwithdignity.org .
A Durable Power of Attorney for Health Care (also known as an advance medical directive) allows you to designate someone (sometimes referred to as a health care proxy, or agent, or attorney-in-fact, or surrogate) in advance to make health and medical care decisions if you are unable to.
Keep in mind each state regulates the use of advance directives and living wills differently. Consult with an attorney or check with your state’s website before preparing these documents.
Second, you can always revise and update the provisions in your living will and advance directive.

Third, make copies of these documents and have them easily accessible. You may want to provide copies to your proxy as well as your doctor, medical facility and attorney.

Most importantly, have these conversations (tough or otherwise) with your loved ones now, BEFORE an emergency happens. As Linda and Bruce found out (two blogs ago) you never know when it’ll ‘hit the fan.’

Sig

When You Are the One and Only Caregiver

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Occasionally we meet individuals whose first response to our mentioning Tough Conversations is: “I was the one and only caregiver for my (fill in the blank: mother, father, grandparent, etc.)” “Do you have siblings?” we ask. Sometimes we hear no, other times, yes. If yes,  “Weren’t you able to get their support, or access help from other sources?” is our next query. Again, sometimes yes, other times, no.
The bottom line among many families is that one adult child becomes ‘the one and only’ caregiver; the sole custodian of financial and health care responsibilities, or end-of-life and change-of-residence needs.
Some have nowhere else to turn; others call on social service agencies for assistance. One friend commented that she was so focused on caring for her parents, she never thought of asking others for help. As a result her memories of caring for her mother are filled with resentment, anger, and fatigue.
For those of you who are or were “the one and only” we invite you to share your insights of what it is (or was) like be a sole caregiver. There must be many of you flying alone. What can we learn from your experience? What advice, suggestions, or counsel would you share with others? What kinds of tough conversations do you wish had taken place but never did?
We hope you’ll share your thoughts about what it’s like to be ‘the one and only.’
Sig Cohen