Advance directives can ease crisis

Published 8:22 pm Monday, April 12, 2010

Every day in hospitals, nursing centers and private homes, patients, residents and families make pivotal decisions about medical care at the end of life. These decisions range from demanding every high-tech tool in the medical arsenal to extend a patient’s life, to comfort care measures that can ease the passage of a patient in hospice. They can be the most difficult decisions family members and designated healthcare agents ever face.

Early guidance from the patient in the form of an Advance Medical Directive can reduce family disagreements and ease the emotional burden of these decisions. It is also helpful to know that comfort care does not mean “giving up.” It is an active medical protocol focused on pain relief and symptom management that allows patient and family more quality time together.

Sometimes the decision is clear, such as a declaration of brain death after an accident, stroke or aneurysm. However, when a patient’s condition and prognosis are less defined, the absence of an AMD can cloud health care decisions with doubt, guilt and uncertainty over what the patient would want.

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From April 12 to 16, Sentara Healthcare will sponsor our ninth annual Advance Directives Awareness Week. Our event coincides with National Healthcare Decisions Day on April 16.

Both encourage people to file Advance Medical Directives while they are able to discuss their end-of-life wishes with family members and designate an agent for health care decisions if they become incapacitated. In Virginia, if you have not filed an Advance Directive, your spouse automatically assumes the role of agent.

In some families, another person might be better suited to that role, such as a sibling, an adult child or a trusted friend. The agent you name in your Advance Directive should be someone who understands your views on end-of-life care and will carry out your wishes.

Since 1990, when Congress passed the Patient Self-Determination Act, health care institutions have been educating their communities about patients’ rights to accept or refuse medical care and to file Advance Medical Directives.

More than 30,000 AMD documents are currently on file with Sentara Healthcare. As an added benefit, Sentara offers free registration with the U.S. Living Will Registry, which makes your AMD available to participating hospitals nationwide. The Sentara eCare Health Network, our electronic medical record, provides a secure link to the national registry, which speeds access to your document.

Let me emphasize that Advance Medical Directives may also dictate the level of care patients do, want as well as what they don’t want. For instance, if a patient is in a coma, or persistent vegetative state, an AMD could state that you want to be kept on life support for a period of time to see if you spontaneously recover. Another patient might want to be taken off life support immediately.

AMDs can address such issues as pain management, IV nutrition and hydration, kidney dialysis, resuscitation after cardiac arrest and a host of medical treatments and interventions that family members might not think about until the moment when they have to decide for a loved one who cannot.

Executing an Advance Medical Directive does not require a medical vocabulary or a law degree. Advance Directive forms offer straightforward language about what kind of care you want.

An attorney in Family or Elder law can be helpful, but a lawyer is neither necessary nor required. You can find more information and necessary forms at

As a hospital chaplain, I can tell you from experience with many families that patients with Advance Medical Directives have better deaths. They leave their families in a more peaceful place, knowing they carried out a loved one’s stated wishes.

I believe the greatest gift you can give your family is your wisdom and guidance in end-of-life healthcare decisions through an Advance Medical Directive.

DAVID COCHRAN is a chaplain at Sentara Leigh Hospital in Norfolk. He also serves as an ethics consultant and subject matter expert on advance directives for Sentara Healthcare.