Advance directives make choices clear

Hospices should work with their medical practice partners to develop a process in which patients are informed early about advance care directives. Experts suggest that when people create an advance directive, they should provide more detailed information than is required by state law and expand on their wishes regarding how matters should be handled at the time of their death. In the advance directive, patients should clarify their beliefs on various medical procedures, attitudes about organ donation, views on health, and thoughts about independence and control.

The Journal of the American Society of Certified Life Underwriters provides guidelines to help people make end-of-life decisions in four situations:

  • if the patient were in a coma or persistent vegetative state;
  • if the patient were in a coma and might survive;
  • if the patient had brain damage;
  • if the patient had brain damage and a terminal illness vs. no terminal illness.

In each situation, several medical treatment options were offered, such as CPR, a ventilator, nutrition and hydration, surgery, chemotherapy, invasive tests, blood products, and pain medicine. Under each treatment option, people could mark one of the following four options:

  • I would want.
  • I want treatment tried; if no clear improvement, stop.
  • I am undecided.
  • I don’t want.