Raising Awareness on Advance Directives

Benjamin Franklin once said, “in this world, nothing is certain except death and taxes.” If April 15 is traditionally recognized as “Tax Day,” does that mean there’s a “death day” somewhere on the calendar? Not necessarily, but the day after the tax deadline happens to be devoted to talking about death. April 16 is recognized as National Healthcare Decisions Day. It’s a day for asking the tough questions about what should happen when the end is near.

At Moffitt Cancer Center, patients are asked during their first visit whether they possess or need help completing an advance directive. An advance directive includes a written statement of the patient’s choices regarding medical care, known as a living will, and a designation of a healthcare surrogate to make decisions should they become unable to communicate those wishes. This helps healthcare providers, family and caregivers ensure the patient’s wishes are carried out should the patient’s disease get to the point where they’re no longer able to speak for themselves.

“For many patients, that first day is usually very busy and advance directives may not be foremost on their minds,” said Marc McDowell, a licensed clinical social worker at Moffitt. “Our social work staff is ready to assist with the proper paperwork and guidance to help put those wishes into writing.”

Part of that decision making process involves choosing how much or how little medical care you might want. This includes reflecting on your values and deciding if quality of life is more important than quantity, and what does quality of life actually mean for you? Having a written advance directive allows you the ability to choose specific measures you want healthcare providers to take or not take to prolong your life. It also allows you to decide when certain measures are too aggressive, and you would like to pass peacefully.

According to Jolene Rowe, a licensed clinical social worker at Moffitt, the more a patient decides in advance, the better we are able to honor their wishes and the less of a burden it is on their family members.

“It’s very stressful for families to have to make these decisions when a patient is critically ill and not likely to recover,” said Rowe. “We really want to encourage our patients to prepare by completing advance directives and including family in the discussion about their wishes. This can make a significant impact on relieving family members of the burden of these decisions at the end of life.”

According to the Conversation Project and Kaiser Family Foundation:

• 92% of people say that talking with their loved ones about end of life care is important
• 32% have actually done so
• 21% of people say they haven’t had the conversation because they don’t want to upset their loved ones.
• 53% say they’d be relieved if a loved one started the conversation
• 97% of people say it is important to put their wishes in writing
• 37% have actually done it.

Advance directives aren’t just for the people living with a deadly disease. While diagnosis and deterioration are just two of the “four D’s.” The other times you should review and update your wishes are after a divorce or following the death of your designated healthcare surrogate.

“Doing this when you’re healthy is so much easier psychologically,” said Rowe. “It’s much easier to talk about what we want when it’s so remote, but to wait until it’s around the corner is very stressful. In the end it’s going to save a lot of grief, pain and heartache.”