SVH officials promoting the importance of ‘advanced directives’

‘Advanced directives' among the most important decisions of your life, says Dr. Robert Cohen|

Creating an advanced directive

Local information and resources are available at mycaremyplansonoma.org.

California maintains an Advance Directive Registry. By filing your advance directive

with the registry, your health care provider and loved ones may be able to find a copy

of your directive in the event you are unable to provide one. You can read more about

the registry, including instructions on how to file your advance directive, and a sample fillable form, at

oag.ca.gov/consumers/general/care#advance

“Crisis is the worst time in the world” to start thinking about what your beliefs are about long term care and other medical issues, says Dr. Robert Cohen, chief medical officer at Sonoma Valley Hospital.

Cohen was an emergency room doctor at the hospital for more than 28 years – and he is “passionate” on the subject of deciding what you want the end of your life to look like before it, perhaps unexpectedly, arrives.

SVH is working in conjunction with “My Care, My Plan: Speak Up Sonoma County,” to help the public become more educated and aware about advance health care directives.

Additionally, Taylor McCandless, a medical social worker with SVH's Healing at Home unit, is helping roll out the hospital's new “Planning Head” community service project. Cohen and McCandless recently participated in an information panel on the subject at Vintage House - and will continue to reach out to the community and accept invitations to speak to clubs, businesses and service groups.

Their message is simple: Your wishes may not be respected at the end of your life if no one knows what your wishes are. Do you want feeding tubes and a machine that breathes for you, or does comfort care and a natural death seem more peaceful?

Regardless of age, they stress, you never really know when illness or an accident may leave you unable to speak for yourself. Patients often arrive alone at the emergency room, unable to communicate and with no family member to express their point of view. And sometimes when family members are called, asked for advice about end-of-life issues, medical personnel are given the answer, “I really don't know. We've never talked about it.”

That's why Cohen believes it's so important to have an Advanced Health Care Directive, which allows you to give instructions about your health care in advance, and to appoint someone who understands your desires to advocate for you if you are unable to do so yourself.

Cohen says that unless an advanced directive asks for less-aggressive treatment, “we will give it the full court press.” Especially among the aging population, he said, sometimes that means that “rather than extending life they are extending death.”

Advanced health care directive forms can be very specific and customized, but the general form asks for either a “choice not to prolong” which specifies “I do not want my life to be prolonged if the likely risks and burdens of treatment would outweigh the expected benefits,” or a “choice to prolong,” which reads, “I want my life to be prolonged as long as possible within the limits of generally accepted medical treatment standards.”

There is additional space for providing any specific instructions regarding questions such as what the patient considers a reasonable quality of life, and what treatments would be considered burdensome or unacceptable.

An advanced health care directive also allows you to name someone to make health care decisions for you if you are incapacitated. It is also possible, if desired, to specify organ donation requests.

McCandless describes it as a “gift to your family.”

“You are taking the burden off them,” said McCandless. “It is a conversation you should be having in a living room, not the ER.”

Cohen has an advanced directive for himself. “I want to donate my body to medical science, so I've made sure that that happens,” he said, in addition to his decisions about long-term care and who is agent will be.

To help with making your choices in advance, the Coalition for Compassionate Care of California has developed a fact sheet, conversation guide and values checklist to help with the decision making process. It explains that having an advanced directive form added to your medical file is not difficult, does not require an attorney, can be changed or revoked at any time, and that you are not required to fill out an advanced directive if you don't want one.

The fact sheet lists questions you might want to ask yourself: If you could plan it today what would the last day or week of your life look like? Where would you like to be, at home, in a nursing home or in a hospital? It even poses less crucial questions: “Is there any particular music, flowers, photographs or art you would like to have around you near the end of life? And asks you to consider discussing preferences concerning a funeral, and burial vs. cremation with your family.

“This is not difficult,” Cohen said, “But it takes a willingness to talk about it. I willingness to be thoughtful.” He said in his experience, people who take responsibility for making end-of-life decisions in advance consider it a positive experience.

Creating an advanced directive

Local information and resources are available at mycaremyplansonoma.org.

California maintains an Advance Directive Registry. By filing your advance directive

with the registry, your health care provider and loved ones may be able to find a copy

of your directive in the event you are unable to provide one. You can read more about

the registry, including instructions on how to file your advance directive, and a sample fillable form, at

oag.ca.gov/consumers/general/care#advance

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