Death is inevitable and as we age it becomes more apparent that we are not immune to this natural part of life. Still, many are not prepared for this difficult time and have not considered who will make the tough decisions for them when they are no longer able to.
By preparing an Advance Health Care Directive, also referred to as an advance directive, you will be making all the decisions regarding end-of-life care and in doing so ease the burden of having your family members make these difficult decisions for you. Advance directives are proven not only to improve quality of care and increase patient and family satisfaction, but reduce stress, anxiety, and depression in surviving relatives.
What is an advance directive?
An advance directive is a set of instructions (usually a written statement) that typically includes two different types of legal documents: individual instructions and healthcare power of attorney.
These legal agreements allow you to spell out your wishes regarding end-of-life care ahead of time so there’s little confusion or uncertainty among your family, friends, and healthcare professionals later on.
Under the Uniform Health Care Decisions Act (UHCDA) enacted in Hawaii in 1999, the commonly held term “living will” was replaced by what we now refer to as “individual instructions.” Individual instructions detail to your relatives (and healthcare professionals) the type of medical care you want and more importantly, the type of care you do not want in the event that you are dying or become permanently unconscious.
Individual instructions may include specifics regarding the use of dialysis, breathing machines, and tube feeding. You can also provide instructions on resuscitation if your breathing or heart beat stops, requests pertaining to organ and tissue donation, and details surrounding life-support treatment and other circumstances under which you do not want to be kept alive.
Healthcare power of attorney
This legal agreement allows you to designate an individual or individuals, to serve as your representative; subsequently giving them the authority to carry out your individual instructions or make medical decisions on your behalf in the absence of such instructions.
Under Hawaii law, you can specify when you want the healthcare power of attorney to go into effect—regardless of whether you are capable or not of making decisions for yourself. You may also designate an alternate representative, if your first choice is unable or unwilling to act on your behalf. However, representatives cannot be an owner or an employee of a healthcare facility where you are receiving care, unless that individual is a relative.
Preparing an advance directive is not required by law and Hawaii does have specific legislation surrounding health care decision making for incapacitated individuals who either do not have an advance directive or have no designated health care representative or guardian.
How do I complete an advance directive?
Even if your family is aware of your wishes regarding end-of-life care, it’s a good idea to prepare an advance directive regardless. Forms can be obtained directly from the state, but forms from other sources are acceptable provided they meet state law requirements. It’s also advisable that you speak with an attorney or legal professional as well as your healthcare provider before filling out these important documents. These professionals can explain your options and help you set goals for treatment and care with close attention paid to quality of life, independence, and emotional and physical well-being.
Your advance directive should be saved with in your medical files and distributed to any and all healthcare providers from whom you are receiving care. Be sure to also share it with the individual(s) you have asked to serve as your representative if your advance directive includes a healthcare power of attorney. Hawaii residents also have the option of including the initials AHCD on their driver’s license, so that in the event of a life-threatening emergency, first responders will be aware that specific instructions regarding medical care have been set forth and action should be taken accordingly.
Preparing for the end of life is not something you look forward to doing nor is it an easy task to undertake. But making preparations ahead of time not only provides clear guidance to health care providers, but also limits the possibility of disagreement among family members regarding your medical care. In fact, many have described advance directives as the best gift you can give your family.