Advance directives crucial for patients
DEAR DOCTOR: At my last physical exam, my doctor gave me an advance directive form. Do I really need to fill one out?
DEAR READER: Unequivocally, yes. Advance directives are forms providing direction to both family members and the medical community about your wishes in emergencies. They specify what your wishes are, in case you can’t speak for yourself.
The first part of an advance directive asks whom you would want to make medical decisions for you. Termed a medical power of attorney, this can be your wife, one of your children or a very good friend. It cannot be your doctor.
The crucial aspect of this choice is the level of trust you have in your decision maker. If you were to lose decision-making capacity, this person would speak with doctors about your care on your behalf — becoming both your advocate and the person who chooses resuscitative measures, if any.
Not only should you trust the person to whom you give medical power of attorney, you also need to have frank conversations with that person about what you would want.
If you were hospitalized for a heart attack,
stroke or a traumatic brain injury, what choices would you want to make? If you were unable to breathe, would you want a tube, attached to a ventilator, placed into your lungs? Would you consider a tracheostomy, if you were on a ventilator for more than two weeks? How about a feeding tube that enters your stomach through your skin? For how long would you want such measures?
These are not easy topics to consider, or to discuss with the ones you love. But they are important.
Ideally, doctors could help with the discussion about end of life, but because the nature of doctors is to treat and heal, many have difficulty discussing end-oflife decisions with their patients.
Death is an inevitability. Providing your loved ones, the medical system and yourself direction about your course of care gives you some control over that inevitability.
Robert Ashley, M.D., is an internist and assistant professor of medicine at the University of California, Los Angeles.
Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA 90095.