Instructions remove mystery from dying wishes

Advance directives make choices clear

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. That’s why Elaine Glass, RN, MS, AOCN, clinical nurse specialist at James Cancer Hospital in Columbus, OH, wrote what she refers to as her "values history" form.

In this document, she states her beliefs on various medical procedures, her attitude about organ donation, her views on health, and thoughts about independence and control. "I comment about not wanting to be disabled and physically limited in my movement," she explains. It includes her overall attitude about life, her religious background, and her beliefs about God and heaven.

There are other ways to provide pertinent details within advance directives, says Glass. Several years ago, the Journal of the American Society of Certified Life Underwriters published guidelines for making end-of-life decisions in four situations:

• if I were in a coma or persistent vegetative state;

• if I were in a coma and might survive;

• if I had brain damage;

• if I 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.

Detailed instructions in writing remove any mysteries about the patient’s dying wishes. "A lot of physicians are uncomfortable in trusting families to make decisions that aren’t in writing, because they don’t know if the family is just after their inheritance," says Glass. n

For more information about education and support around end-of-life issues, contact:

Elaine Glass, RN, MS, AOCN, Clinical Nurse Specialist, 004 James Cancer Hospital, 300 W. 10th Ave., Columbus, OH 43210-1240. Telephone: (614) 293-4553. Fax: (614) 293-6037.

Michelle Goffney, BSW, MSW, LCSW, Director of Social Services, Deborah Heart & Lung Center, 200 Trenton Road, Browns Mills, NJ 08015. Telephone: (609) 893-1200, ext. 5301. Fax: (609) 893-5064. E-mail:

Karen Kent-Metteer, MDiv, Lead Chaplain, City of Hope National Medical Center Pastoral Care Services, 1500 East Duarte Road, Duarte, CA 91010-3000. Telephone: (626) 359-8111, ext. 3317. Fax: (626) 930-5335. E-mail:

Shirley Otis-Green, ACSW, LCSW, Clinical Social Worker, Supportive Care and Palliative Medicine, City of Hope National Medical Center and Beckman Research Institute, 1500 East Duarte Road, Duarte, CA 91010-3000. Telephone: (626) 359-8111, ext. 2783. Fax: (626) 256-8798. E-mail: