Melissa Kaplan's
Herp Care, CND, & Lyme/TBD Collection
Last updated January 1, 2014

Advance Care Directives

Having a say when you are unable to speak for yourself.

For those readers who are familiar with my Herp Care, CND, and Lyme information collections, this Advance Care Directives collection may seem like a departure for me. But in fact, I have had information on ACDs and other end-of-life issues in my CND website since its inception over a decade ago. Through the loss of my sister, mother, and husband during the past 20 years, occasional talks with friends about what we do or do not want, the end-of-life and DNR (do not resuscitate) issues raised in legal and medical dramas and books, and tragic real life examples, well, my nagging people to create and maintain their own ACDs just comes naturally.

An Advance Care Directive (ACD), also called Advance Health Care Directive (AHCD), is the primary way you can document your very specific wishes as to what you do and do not want done to prolong your life should you become incapable of speaking for yourself.

Few people like to think about dying, and fewer still sit down and think through the decisions that will need to be made if they become incapacitated. Finding the time in our busy days to locate the forms, think through the specifics of what we want and writing them down, getting the forms notarized, copied and distributed - well, it is all to easy to put it off until you have some time.

The problem is, we never know how much time we have. As the tragic case of Terri and Michael Schiavo shows us, incapacity doesn't just happen to "old" people. If you are old enough to vote, you should have an ACD.

If what happens to you is important to you, you cannot rely on everyone in your family to abide by anything you said. No matter how much your individual family members may love you, too many will do what they would want done for themselves, or to selfishly keep you around as long as possible, "just in case", regardless of your wishes, if your wishes are not specifically written down in a format approved by the state in which you live, are notarized and copies filed with those you have empowered to act on your behalf, your physician, and your attorney, if you have one.

ACDs aren't something you make once, and then stick in a drawer somewhere. Like a Will, you need to schedule reviews at regular intervals, as well as during and after major events in your life, such as marriage or domestic partnerships, the birth of children, legal separation, divorce, and the death of anyone named in your Will or ACD.

You also need to update your ACD when you change primary care physicians or any physician named in your current ACD. If you move to different state or country, you should check to see if your current form will be accepted in the courts there. You may need to re-create your ACD on a new form, but the time and trouble will be well worth it should anything happen to you.

One very important thing I learned when updating my ACD and appointing a new primary to act for me, is that her idea of what I wanted was very different from mine. For example, she thought I would want to be kept alive, on a respirator and other life support, if I had a cervical fracture resulting in permanent quadriplegia. Absolutely not, I said. And so we got into the nitty gritty of what exactly I meant. Which made me realize that when I next update my ACD, I will be far more specific in what I write in there.

Another important thing I learned is that you can specifically exclude individuals from having any say in making decisions or being part of the decision-making process. All ACD forms have a place for the maker to insert stipulations that do not fit elsewhere in the form. Here you can put language to the effect of:

"I specifically exclude and bar my [relationship], [First Middle Last], from any participation in my care and end-of-life decisions-making. [Name] is not to be consulted by my physicians or managed care team, nor are his/her wishes to be given any consideration by those designated as my primary and secondary decision-makers in this instrument."

What are you waiting for? Read up on ACDs, select the form appropriate for your state, talk to your loved ones and those who you want to appoint to act for you, and get it done.

As Rabbi Hillel said, "If I will not be for me, who will be? If not now, when?"

Information
American Bar Association's Legal Guide for the Seriously Ill: Seven Key Steps to Get Your Life In Order

Healthopedia: Advanced Care Directives

MedTerms.com: Definitions

Putting Final Wishes in Writing Helps Prepare Family for Death

USLivingWillRegistry.com

Making Health Care Decisions

Advance Health Care Directive Checklist

Considerations When Naming A Health Care Surrogate (refers to ACD/POAHC)

California Code for Temporary Verbally Appointed Medical Surrogates

Forms
AgingWithDignity.org

California Coalition for Compassionate Care