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| Home > Healthy People > July 2004 |
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Advance directives communicate end-of-life wishes, eliminate guesswork
for families
St. John’s ethicist Dan Dwyer, PhD, MSW, is on a crusade of sorts.
He’s trying to get the word out to the community about the importance of
advance directives, which are documents written before serious illness
strikes that state wishes about future health care, or name someone to
make decisions for you if you cannot make your own decisions.
 Advance directives have legal force only if the patient becomes unable to
make health care decisions for himself and can be a living will, durable
power of attorney for health care, personal letter with end-of-life wishes
stated, a values history or a medical directive. |
“I spend a lot of time talking with families as they are making
end-of-life decisions about the care of a loved one in the hospital, such
as withholding or withdrawing life-sustaining treatment in the presence of
a terminal illness,” Dwyer says. “Many of these ethical decisions I help
families with are the result of the patient not having an advance
directive to communicate her wishes about end-of-life care in the event
she can no longer speak for herself.”
Dwyer recommends that anyone diagnosed with a chronic illness complete an
advance directive.
“Many patients first hear about the advance directive from their primary
care physician. Others are aware of the importance of the advance
directive because of their own experiences with a loved one who did not
state his or her wishes about end-of-life care, and the family had to make
those decisions for that person,” Dwyer says. “You can always update and
amend the advance directive.”
Advance directives must be notarized and witnessed, and the person
completing them must be competent. Once the advance directive is
completed, Dwyer suggests keeping a copy at home, at the physician’s
office and bringing a copy to the hospital upon admittance.
“What’s good about completing an advance directive sooner rather than
later is that it gives the person a chance to have a conversation with his
family about his end-of-life wishes, before he’s actually dying.
Discussing wishes is very helpful for the relative the person has
designated as her surrogate decision-maker, in the event the person cannot
speak for herself,” Dwyer says. “It also allows the person to really see
whether the relative is actually up to being his surrogate decision-maker,
because some people have a very difficult time in that role.”
Faith traditions often play an important role in end-of-life care
decisions, Dwyer says, and completing an advance directive before the
onset of a terminal illness gives people the opportunity to discuss their
end-of-life wishes with their minister or cleric.
Dan Dwyer will offer a series of workshops for those interested in
assistance completing advance directives as well as for those who have
been designated surrogate decision-makers. Call St. John’s Ethics Program
at 417-820-2153 for more information.
Where can I get an advance directive?
Your primary care physician
Your attorney
St. John’s Ethics Program, 417-820-2153
St. John’s Health System’s Web site:
http://stjohns.com/patientvisitorinfo/images/adenglish.pdf
Community Alliance for Compassionate Care at the End of Life’s Web site:
http://www.missouriendoflife.org
Missouri Bar Association’s Web site:
http://www.mobar.org/pamphlet/livewill.htm
Midwest Bioethics Center’s Web site:
http://www.midbio.org
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