Advance health care directives are a gift to your loved ones

After her mother died recently, a friend and former colleague told me about the “greatest gift she ever gave me.” It was the gift of knowing what her mother’s wishes were at the end of her life.

Even as we experience wave after wave of Covid, no one thinks they are going to die soon. It is certainly not fun to think about death, but having an advance directive can spare your family enormous aggravation and anguish.

An advance health care directive (AHCD) involves two major choices. 1, Documenting specific instructions about your care in the event you are unable to speak for yourself. This can range from aggressive medical care to comfort measures only, and whether or not you wish to be an organ donor. 2, Choosing someone you trust to make health-care decisions for you if you are incapable of doing so.

If you are unable to speak for yourself, your agent can make decisions about tests, medications, surgery, artificial nutrition and hydration you could receive. After your death, the health-care agent will make decisions about the care of your body, including possible autopsy.

If you already have an AHCD, consider revisiting it every decade — even more frequently if your health-care agent changes, or if you find out that you have a new or worsening health condition, or if you’re declining in health and no longer independent.

Selecting who you want to be your health-care agent is crucial in fulfilling your end-of-life care wishes. Even the most detailed advance directive cannot address all the medical nuances of every decision that must be made. It is more important that your health-care agent know about your personal, cultural and religious values and wishes than know a lot of medical information.

A friend of mine expressed relief after he completed his advance directive, but when he revealed that he chose his doctor as his agent, I pointed out that this was not allowed in California.

Here are some considerations in selecting an agent: Someone who will honor your wishes, someone who is concerned about your happiness and well-being, someone who can understand complex situations, and someone who is competent in making difficult decisions, especially when emotions are involved.

It may not be easy to initiate a discussion about advance-directive planning. For example, my mother could never talk about anything related to death. She would never wear anything black because the color was associated with mourning. Shortly after my father died, I took advantage of the opportunity to have a discussion with her about her end-of-life wishes. I was fortunate to have done so, because many years later she did not have the mental capacity to make these decisions.

When you consider that as many as one-third of seniors eventually develop some form of dementia, you can understand why it is so important to document your health care wishes in advance.

Here are a couple AHCD forms: This one is from the state of California, and this one is from Kaiser Permanente (anyone can use it).

Once you complete your directive, you can either have it signed in the presence of two witnesses, or in the presence of a notary public. If you choose to have two witnesses, note that at least one of them must be unrelated to you, neither witness can be your health-care agent and neither witness can be your health-care provider.

Don’t hide away your AHCD in a filing cabinet. Send a copy or email it to your doctor so it becomes part of your electronic medical record, and give copies to your health-care agent and family members.

For further information and classes to help you complete an advance-care directive, I recommend “Take Charge” workshops through Mission Hospice, an online class through your local Kaiser Health Education Department (free for Kaiser members) and/or the book “A Beginner’s Guide to the End.”

Before you discard this column and forget about it, consider completing or updating your AHCD as soon as you can. You will have the satisfaction of providing an invaluable gift to your loved ones.

Dr. Jerry Saliman

Jerry Saliman, MD, retired from Kaiser South San Francisco after a 30-year career and is now a volunteer internist at Samaritan House Medical Clinic in San Mateo.