National Health Decisions Month

Sharon Kelly West

April is National Health Decisions Month in the US. What exactly does this mean?

By Sharon West

April is National Health Decisions Month in the US. What exactly does this mean? It means that this is the time of year to focus on planning your Advance Care Directives.

These directives are documents declaring your medical preferences and/or declaring a person as your proxy or agent to speak on your behalf about medical preferences in the event you are not able to speak.

For example: what if you were in a motor vehicle accident, you were in critical condition, and because of that, you are unable to voice your preferences about being placed on a ventilator, hooked up to a feeding tube, donating organs and/or tissue if you die, etc. If you were in that situation, who would know your preferences?

The area of advance care directive planning has been of special
interest to me for more than ten years. I conducted focus groups last
year and inquired of willing participants their knowledge of advance
directives. The conversations were so interesting and the people who
participated, both through various churches within the African American
community and among the general public, were wonderful to share their
thoughts.

It was interesting that some individuals felt their spouse,
child(ren), sisters or brothers would be their voice in such a time as a
medical crisis. In a few of the sessions, various members of that
person’s family were present and stated, “I don’t know what you would
want me to do.” It is fine to designate your loved one as a health care
agent/proxy—but make sure they know you are assigning them this duty,
and that they know your wishes. Provide them a copy of your written
instruction.

You should not assume that only elderly people should have these
conversations with loved ones and then complete these documents. There
are at least three notable cases in the US that prompted support of the
completion of these documents by adults. Each one of these cases
involved young adults in their mid- to late twenties; they were involved
in tragic situations that required decision-making about treatment, and
because of their circumstances they were not able to participate in
these decisions.

We all remember the case of Terry Schiavo several years ago. She
had neither prepared written documents nor designated a health care
agent to voice her wishes. The nation was glued to the television as the
decision was handed down to discontinue tube feedings—against the
wishes of her parents, but in agreement with the wishes of her husband.

More recently there was a case of a woman in her late fifties who
was the caretaker of her grandchildren. Her children worked full-time,
and she valued her role, though she had no insurance and no income. She
also had no advance care directive. One day she suffered a severe stroke
that rendered her unconscious.

After 18 months of care, the hospital wanted to remove tube
feedings and place her in a skilled nursing facility (nursing home).
Despite the wishes of her children that she continue receiving tube
feedings, they were stopped, and the children were forced to hire an
attorney to assist them.

Two weeks later, the tube feedings were resumed, but only until
next steps could be sorted out on what is best medically for this
patient. What a heart-wrenching, difficult situation! In my many years
as a nurse, I have seen too many cases such as this.

Below are links to advance care directive information. My
personal favorite is the “Five Wishes” document, available at
www.agingwithdignity.org/five-wishes.php. The IMPACT© program in
Asheville will provide this document at no initial cost to churches that
qualify under the program. For more information on IMPACT© go to:
www.sharonkellywest.com.

The state of North Carolina also has a document online (it is a
little wordier however the information is clear):
www.nclifelinks.org/Advance_Directive_for_a__Natur.pdf.

Consider the information I have shared. Have these discussions
with your loved ones. It will be a gift to them in a time of crisis.