National Healthcare Decisions Day an Opportunity to Make Your Wishes Known

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VNA Care Network & Hospice is part of a national, grassroots effort to ensure all adults with decision-making capacity have the information and opportunity to communicate and document their future health care decisions. National Healthcare Decisions Day will be celebrated on April 16.

With the Patient Self-Determination Act of 1990, Congress affirmed the right of every citizen to set forth his or her future healthcare wishes in writing with an "advance directive." In Massachusetts, a free legal form known as a health care proxy allows you to designate a person to speak on your behalf should you be unable to make health care decisions for yourself.

Just complete the proxy, sign it in front of two witnesses, and give copies to your designee (the person you ask to make health care decisions) and health care providers. The form is only put into use if your doctor determines you are unable to make health care decisions. You can cancel the form anytime you wish. The form is available at no cost by calling VNA Care Network & Hospice at 800-728-1862 or e-mailing info@vnacarenetwork.org.

Choosing an Agent

The person you choose to speak for you is called the agent. Although not necessary, you can also appoint an alternate agent who would be called upon if your agent were unable or unwilling at the time. VNA Care Network & Hospice's home health care and hospice staff advises choosing someone you trust to make decisions based on your personal preferences and values. Your agent and alternate should agree to take on this role and be able to make decisions under stressful situations.

Completing the Proxy

When completing the health care proxy, it is important that you and the two required witnesses properly sign the form. Your agent and alternate agent can be anyone of your choosing, except an employee or administrator of a health care facility where you receive care unless that person is a relative by blood, marriage, or adoption. The witnesses cannot be the agent or the alternate agent. There is an optional place on the form to have the agent and alternate agent sign statements. Although it is not required, the health care professionals of VNA Care Network & Hospice recommend having them sign to assure they understand their role in your future health care.

Making Your Wishes Known

A key step in this process is having a conversation with your agent and alternate agent about your personal preferences for health care should you not be able to communicate them for yourself. Tell them you do not want them to feel the burden of making decisions without knowing what you wish.

VNA Care Network & Hospice's health care professionals recommend starting this process by reflecting on what is important to you about care at the end of your life. Do you have certain cultural or religious beliefs which might influence your wishes? How do you feel about life-prolonging treatments, such as resuscitation or mechanical ventilation, if the expectation was that you would never be able to interact meaningfully with your family and friends again? How important do you view pain and symptom control in the management of your illness even if the medications make you drowsy?

You might want to discuss your thoughts with others who might help you sort through your values and options. Your physician or clergy member may be especially helpful.

Then talk with your chosen agent and others who are close to you. VNA Care Network & Hospice's home health care and hospice providers recommend including family members in the conversation so everyone is clear about your choices. Don't assume they know your wishes.

Be clear about your wishes, giving examples of when you would want life-prolonging treatments started, when you would not want them started, and when you would want them withdrawn.

Personal Wishes Statement

Consider putting your wishes and choices into writing. Currently, there is no legally binding form for this in Massachusetts, but written statements can be used as a guide by your agent and your health care providers in making decisions for you if you are unable.

VNA Care Network & Hospice offers their own patients and the community a form called a personal wishes statement. It includes a list of various life sustaining treatments that you may or may not want your health care agent to pursue on your behalf as well as space to write additional considerations.

In all cases, be sure to communicate with everyone who might be involved in decisions for you, especially your agent(s) listed in the health care proxy and your physician.

Resources

VNA Care Network & Hospice provides free health care proxies and personal wishes statements by mail. Information and health care proxy forms are also available in Spanish and Vietnamese. Call VNA Care Network & Hospice at 800-728-1862 or e-mail info@vnacarenetwork.org.

Posted: April 9, 2009