For older adults or people with a chronic illness, taking the time to prepare an advance directive will ensure that their medical wishes are followed if one day they can no longer speak for themselves. Advance directives also are a good tool for adults of any age to prompt them to think about and express their health care goals, says Neil Wenger, MD, director of the UCLA Health Advance Care Planning Program.
UCLA Health has developed its own form to guide people in determining what they value for quality of life. People completing the form can also specify what type of medical intervention they would want in an emergency or at end-of-life, but what makes the UCLA advance directive special is that it focuses on goals and future health states. Additionally, the advance directive form allows people to appoint a health care agent — a family member or trusted friend, for example — who is legally authorized to make medical decisions for them, if necessary.
“The UCLA advance directive is a pretty special document that we developed with patients and doctors in mind,” Dr. Wenger says. “It is important so that people’s goals for medical care are clear and get carried out even if they can’t tell the doctors what they want. It also covers who they would want to make decisions for them if they can’t make them themselves.”
The UCLA Health advance directive is oriented toward goals and preferences rather than treatments. “The first thing it asks of the patient is to tell us about their goals and values. Tell us about health states that they don’t want medical care to keep them in and the things they’re hoping medical care will achieve for them,” Dr. Wenger says. “The form also asks about religion and spirituality, and if that’s important to you. After that, we know a lot about you, and we’re going to use this information to help make decisions throughout the course of your care.”
In addition to providing guidance to the physician, an advance directive gives family members the direction that they need. “We find that good conversations around completing an advance directive help a family member make better decisions and be much more comfortable with the process,” Dr. Wenger says. “There are data showing that under difficult circumstances when people die, families do far, far better if there’s been advance care planning.”
In every case, it is essential that the person who is designated as the patient’s health care agent also have a conversation with the patient about what they wrote down. “It’s often hard to predict what someone would want,” Dr. Wenger says. “Would it be acceptable for someone to end up in a health state where they’re not able to take care of themselves? Many people would say absolutely, and others would say not on my life.”
It is important to keep in mind that while an advance directive is a durable power of attorney for health care, a legal document, it doesn’t require a lawyer and it shouldn’t cost anything unless one wishes to have it notarized.
“End-of-life is a common time for there to be high emotion,” Dr. Wenger notes. “Sometimes family members don’t agree and have different perspectives on what should happen with a patient. That is far less likely to occur if you have an advance directive. It’s the doctor’s responsibility to follow the patient’s wishes, even over the wishes of a family member.”