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Ohio Department of Aging Boomerang: It all comes back to you!

Boomerang: It all comes back to you!

My Future - April 2012

Continuing conversations are key to relieving the pain and stress of tough situations
Advance care planning should be about more than filling out forms

By John Ratliff, Boomerang Staff

When my older brother died several years ago, it caused my entire family to evaluate everything we knew about making health care decisions. Edd's hospitalization was brief, but my parents and I were still left to make many important decisions about the care he would want if he had been able to communicate his wishes himself. I had always contended it was easy to read my brother's mind, but it's not until my family had to decide for him whether to approve life-sustaining treatment that I realized how utterly impossible it was to know what another person would choose if you never discussed it with him.

Advance care planning is a process of examining your beliefs and values regarding health care.After Edd's passing, my parents, my wife and I had several conversations about the types of care we would want if we were incapacitated. We discussed several scenarios, and we all felt very strongly about what we would want done - or not want done - if we found ourselves in Edd's situation. We all agreed that planning was key, but none of us wanted to do what it takes to ensure that our wishes are honored. That's because the process of advance care planning can be daunting. It turns out we're not alone. According to a recent study, more than 80 percent of those polled believed it was important to have their end-of-life wishes in writing, yet only about 40 percent said they had talked with loved ones about the subject, and less than a quarter of them had actually documented their preferences.

Advance care planning is a process of examining your beliefs and values regarding health care, and it involves some formal steps, like documenting your wishes and designating a trusted person to act as your agent. But, it's more than just dictating what decisions you want made and by whom; documents cannot anticipate every possible situation. It's important to treat planning as an ongoing process in which the entire family is able express their collective goals about health and medical treatment and identify and clarify their personal values. Your plan should prepare everyone in the family not just to make decisions for one another, but to actively participate in medical decisions.

When families are open and honest about their preferences, they are able to build trust between themselves and the medical professionals providing their care. Since the entire family knows what the loved one prefers, much of the anxiety, uncertainty and conflict associated with crisis situations can be reduced or avoided. It starts with conversation. Involve everyone who wants to have a say, but be sure that the person you are planning for is in the driver's seat. Also, make sure the conversation moves successfully from the vague to the specific. A loved one may say, "I would never want to be kept alive on a machine." That seems to be a clear statement, but do you really know what it means? Ask probing questions: What if the prognosis is unclear? Would their wishes change if their condition were readily reversible? Explore many circumstances to really learn what is important to your loved one.

When you have taken the time as a family to learn and understand each other's values and wishes, each person should document his or her personal preferences. In Ohio, the living will and the health care power of attorney are valuable advance directives that have been proven effective. Midwest Care Alliance (www.ohpco.org), a state advocate for excellent care in many settings, offers two free guides to help your family discuss and document your plans. Conversations That Light the Way is a workbook that helps families and individuals make choices about healthcare throughout life. Choices: Living Well at the End of Life is a planning tool that includes copies of Ohio's approved advance directive forms.

Remember, life is a continuum - as our lives and situations change, so must our plans. Revisit your plan and documentation regularly, but especially after major events such as injuries or serious illness. Most importantly, keep the conversation going so that so everyone can express their wishes, and no one will be left guessing what to do.


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