Advanced Directives: Honoring Your Wishes

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Timothy Shafer

By Dr. Tim Shafer, Grace Cottage Family Health

I would like to discuss a topic that is always important but especially now, in these sobering times when we are more aware of mortality. If you have not already done so, I urge you to complete an Advanced Directives for Healthcare, sometimes called a Living Will.

Both of these terms refer to a written document stating your choices about the extent of healthcare you would desire in response to a severe illness, serious injury, coma, advanced dementia, terminal condition or other critical medical situation. It documents your beliefs in case you are incapable of communicating when the event occurs. You can also specify your desires regarding pain management and organ donation.

Modern medicine has the power to keep people alive despite terrible illnesses and injuries. We have surgeries, intensive care units, CPR and defibrillators, artificial ventilation, feeding tubes, and kidney dialysis. All of these can be blessings if they lead to recovery.

Tragically, they can also keep people hovering for weeks, months or even years between life and death. We can be kept alive, living on machines, even though we cannot think, function independently, recognize faces or voices, or experience joy.

We should all ask ourselves: Under what circumstances is life worth living?  How much medical intervention and perhaps suffering are we willing to experience to survive?  Do we want to live if we cannot take care of ourselves, recognize loved ones, comprehend communication, share a laugh, or experience joy?

As you fill out the Advanced Directives form, you will be asked to explore these questions, record your beliefs, and specify your preferences.

For instance: “Would you want to be put on a ventilator (artificial breathing machine)?” Possible answers include: (a) “Never;” (b) “Short-term to see if I improve;” or (c) “Put me on long-term no matter what my quality of life is.” Not surprisingly, most people pick (b); but everyone should answer in a way that honors their sense of health and their beliefs. Some people are ready to say “no major life-preserving interventions.” Some are not ready to place any limit on duration of care. Either answer is correct if it honors who you are.

It is valuable to make your own wishes known, no matter what happens. Beyond that, it also makes things easier for your family members, who otherwise may have to make an agonizing decision without knowing what YOU want.

Please talk to the people closest to you. Explore your feelings and make sure they know what you most deeply believe. If you become seriously ill, you do not want loved ones fighting over what should or should not be done on your behalf. Call your medical provider if you wish to discuss your medical conditions and what interventions may or may not make sense at your age.

There are several ways to complete an Advanced Directives. Good news: you don’t need a lawyer! (Although they are glad to help if you ask.)

If you are comfortable on computers, you can go to the Vermont Advanced Directives Registry online (, where you will find information and directions to complete and electronically file an Advanced Directives document that will be instantly available to any emergency or hospital personnel anywhere in the country.

If you would rather do this in person, you can call Grace Cottage RN Patient Care Coordinator Claire Bemis (802-365-3763). She has patiently and compassionately helped many people through this process. Her services are offered free of charge, whether you are a Grace Cottage patient or not.

Or, we have copies of an excellent booklet, “Taking Steps: A Comprehensive Guide to Medical Decision-Making” from the Vermont Ethics Network that includes the paper Advanced Directives form. Stop by to pick up a copy or ask to have it mailed to you.

The Brattleboro Area Hospice organization is also happy to help people with advanced care planning (ACP). Contact their ACP Coordinator Don Freeman at 802-257-0775.

While completing your Advanced Directives, you will appoint a Durable Power of Attorney (DPOA), someone who knows your beliefs and would faithfully make decisions on your behalf if you become incapacitated. I recommend you also choose an alternate DPOA (younger is better). Finally, complete the form, sign it with witnesses, and bring it to your provider to be copied into your medical chart.

Having an Advanced Directives is an act of kindness for your family. It relieves the pressure and guilt that family members may feel when they have to make decisions for you. It’s tough to be in a situation where you want to honor a loved one’s wishes, but you don’t know what they are. A medical crisis is the worst time to make difficult decisions. An Advanced Directives document gives guidance to family members and also to the medical team taking care of you.

If you have an Advanced Directives, I suggest you review it from time to time. Your decisions may change throughout your lifetime, and an Advanced Directives can be revised. If you don’t have one, I urge you to do this as soon as possible. Life is unpredictable.

If you have questions, Grace Cottage is happy to help. Call us at 802-365-3763.