Patched Up!: Make Your Decisions Today

By R. Scott Lake, MD, Director Palliative Medicine Services, Roper St. Francis Healthcare, South Carolina Coalition for the Care of the Seriously Ill member

As a physician caring for seriously ill, hospitalized patients, each day I witness family members’ angst, second-guessing and guilt as they try to decide how to best honor their loved one’s wishes.

Conversely, it is remarkable to see the comfort that family members experience when a patient has an advance care plan in place and conversations about these difficult situations have taken place previously between a patient and their loved ones.

Today (Monday, April 16) is National Healthcare Decisions Day. It is a day dedicated to encouraging people to complete advance healthcare directives, such as living wills and durable powers of attorney. The annual event – just one day after Tax Day− focuses on the inescapable connection between death and taxes and what it means for those left behind.

Unfortunately, the majority of Americans ignore this advice. Only about 25 percent of all Americans have completed advance healthcare directives. That statistic persists despite public surveys in which respondents consistently say they most fear being a burden to their families, losing dignity and personal control. Ironically, people tend to avoid the very discussions that could reduce that burden and enhance a sense of empowerment over the future.

It should be said that advance directives are about more than just filling out a paper document. Directives are most useful when they are based on conversations within families. When someone falls ill or is seriously injured, an advance directive can dissolve family disagreements over treatment options before they arise. In so doing, conflict is averted and family members are better able to support one another and attend to the difficult tasks of caring and grief.

Advance care planning is not a one-stop shop. It is a process that includes revisiting plans through continued conversations between clinicians, patients and family members. And to be meaningful, these conversations must be grounded in the reality of the individual’s overall health status. Certain medical procedures that are reasonable in an early stage of disease may have no benefit in a later stage. In short, “If I am in a coma, pull the plug” does not constitute an advance care plan.

So this week is a good one to start these discussions and complete your own advance directive.

There are many free resources that can assist in the creation of a plan.

Download an advance directive form from the National Healthcare Decisions Day website ().

Go to the South Carolina Hospital Association website to find the following documents on advance care planning which are excellent tools for anyone: “Isn’t It Time We Talk” brochure and Frequently Asked Questions about advance directives.

(Blank copies of these documents are available at hospitals, most lawyers’ offices and many doctors’ offices.)

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