Make your last wishes known

Life can change in an instant. Do you have an advanced directive?

Traumatic injury or illness can happen at any point in life.

Do your loved ones know your wishes if — today — you have a debilitating stroke or your vehicle gets T-boned?

If you become unresponsive, would you want a breathing tube placed in your throat? A tracheotomy tube? Would you want to be tube-fed? Would you want extraordinary measures taken to keep you alive, even if your chances of a good quality of life are unlikely?

It's time to talk with family, friends, church family or coworkers — the people you might choose to make medical decisions if you are unable to make them, local advocates say.

"Life can change in an instant. Anyone can have a serious injury from a car accident, sports injury or fall," says Mayo Clinic's advance directive, a document community members can fill out to help guide loved ones if the unthinkable happens.

Health leaders at Mayo suggest that, instead of worrying about specific hypothetical events, you should concentrate on sharing your personal values and priorities, and share those with the people you have designated to be decision-makers if you're not able to speak for yourself.

Key to a successful advance health-care directive is picking a "health care agent" — the person you pick to speak for you. That's a person, according to Mayo's advance directive, who will act based on what you want — even if other people who are "close to you want something else."

"Tell us who you want us to trust," Hellyer said.

Fewer than one-third

Most people know about advance directives. But only about 20 to 30 percent of patients seen at Mayo Clinic have them, said clinical ethicist and registered nurse Joan Henriksen Hellyer, Ph.D., coordinator of the ethics consultation program at Mayo.

"You need to talk about it," said Franciscan Sister Tierney Trueman.

For loved ones, a traumatic event, heart attack or severe stroke can create scenarios where it's uncertain what to do next — and that's when an advance directive can help ease the burden for both medical professionals and family members.

"We have very few people who have them," said Hellyer, who responds when a medical team and family members are trying to make decisions about potential treatments, pain that might be caused, the patient's desire for no intervention or for extraordinary measures to stay alive and other questions.

Your health-care agent's job, Hellyer said, "is to represent the patient and what the patient would want." That person is obligated to follow the advance directive on your behalf.

Hellyer implores people to get one from their health provider, to fill it out and to discuss it with loved ones.

"If people would do this, it would make my job easier," she said.

Avoid family conflicts

That's because, without an advance directive, it's hard to know how to decide what an unconscious patient would want. When a son or daughter comes from elsewhere in the country and mingles with siblings who've been disconnected in recent years, that can brew discord.

An advance directive can alleviate that problem because the patient has written a guide to follow.

To be a legal document, saidDr. Juliana Perez Botero, who completed an ethics residency program, the advance directive must be notarized or signed by two witnesses.

But even one that's not official is helpful to health providers, especially if no loved ones are available and care decisions must be made rapidly.

When making a decision about your health care agent, Botero said, the spouse is often not the best person to pick because it's hard for a spouse to make dispassionate decisions.

If you pick such a person, fill out an advance directive and share it with that person and your loved ones, "you decrease the burden for family — and guilt," Hellyer said.


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