End of life issues can be hard to talk about. Not talking about them could be even harder.

Why You Need to Prepare

Some people have chronic illnesses, some that may even be terminal. A study in the BMJ Supportive and Palliative Care found that terminally ill people who discussed their preferences for end-of-life care with their doctors actually lived longer and with a better quality of life than those who did not. Deciding how they wanted things to go made all the difference.

You should not wait for an unfortunate diagnosis to start thinking about these issues if and when your health fails you. Natural disasters, car accidents, mass shootings. The unexpected happens every day.

This is why advance directives are so very important. They are legal documents that outline your wishes for medical care in the case you are unable to make those decisions yourself. Whether you are incapacitated by a coma, traumatic injury, or are otherwise unable to make medical decisions (e.g., dementia), an advance directive assures your wishes are honored and takes the burden off your loved ones.

What to Include in an Advance Directive

You may be asked about an advance directive when you face an unexpected diagnosis or when you go to the hospital. However, the best time to think about one is when you are in good health. This allows you to approach the issue with a clear mind and without all that added pressure.

First, ask yourself who you would want to make decisions on your behalf. Think long and hard on that one. Some people love you so much they may do anything and everything to keep you around, even if that’s not exactly what you agreed to. Pick someone you trust, someone who will honor you and what you would have wanted.

Next, you will want to consider specific medical interventions that could extend your life. The following list is not all-inclusive but includes common treatments included in an advance directive.

• Blood transfusions
• Dialysis for failing kidneys
• CPR and/or defibrillator therapy for your heart
• Intubation and ventilator therapy to help you breathe
• Tube feeding and/or IV nutrition

It is important to think about how long these interventions could last. CPR happens at the moment but ventilator treatment could continue for weeks, months, or longer. How long would you want to be artificially fed? Should any of these interventions be stopped if there is a low likelihood of recovery?

How to Get an Advance Directive

There are different types of advance directives you should know about.

• Do Not Resuscitate (DNR)/Do Not Intubate (DNI): This is an order that tells medical professionals to withhold resuscitation efforts (e.g., CPR, defibrillator, intubation) that would revive your heart or restart your breathing. This order can be included as part of an advance directive.
• Health Care Proxy/Durable Power of Attorney for Health Care: This advance directive assigns a person to make medical decisions on your behalf whenever you are unable to do so yourself. You do not need to have a terminal condition for this to apply.
• Living Will: Like a health care proxy, this is an advance directive that assigns someone to make medical decisions when you can’t. However, it can only be used when you have a potentially terminal condition.

Advance directives are legal documents. Many states require that an advance directive be signed by a notary public in the presence of adult witnesses. You can change your directive at any time, as long as you are of sound mind at the time. Be sure to have the updated document notarized according to the laws in your state.

Whenever you prepare an advance directive, it is important to get copies into the right hands. Keep one for yourself but also get copies to your doctor(s) and anyone you have designated as a decision-maker.

If you don’t have an advance directive, a proxy may be assigned to you. Forty-four states have surrogate consent laws that allow family and loved ones to act on your behalf. In other states, a court may appoint someone to make those decisions for you. Despite all these good faith efforts, unless you have taken the time to have those tough discussions with the people you care about, will anyone really know what you would have wanted?