Using Advance Directives to define the care you want

By Kathy Daly MD

What if you were unable to tell people the kind of healthcare you want? Who would make decisions for you? An Advance Directive defines these things so that there will be no question what you want.

ICU

​Advance directives are legal documents that help to ensure that the healthcare you receive is in line with your wishes. In Utah, there are two standard documents generally used. Here’s a quick explanation of each of them:

  • A Physician Order for Life Sustaining Treatment is completed with your physician or medical team. It is generally in response to a specific health condition, and directs your providers on what types of medical care you want provided or withheld, including things like resuscitation, interventions, life-sustaining equipment, antibiotics, feeding tubes, and IV fluids.
  • A Utah Advance Health Care Directive allows you to appoint a healthcare agent — the person you want to have making your healthcare decisions if for some reason you can’t. It also provides a way for you to let your agent know what your wishes are. You can complete an Advance Health Care Directive at any time, whether or not you are sick.

Oftentimes people complete advance directives after watching a friend or family member struggle with a critical illness. When they see someone hooked up to machines in the ICU and unable to communicate, they say, “I don’t want that to happen to me.”

Other times, family members forced to make end-of-life decisions without any input from the patient feel compelled to complete their own advance directive to spare others the same pain and confusion they are feeling.
 
An advance directive says, “I am making decisions about my own health. I don’t want to have that be put on my family.”
 
Be as clear as possible when completing your advance directive. Talk with your physician about your concerns. I want my patients to understand that each decision affects the next. Without an advance directive, a slippery slope can occur leading to interventions an individual did not want. It’s important to say “I want things done up to this point,” and identify clearly what that point is.
 
If we as physicians do our work correctly, we will take time to listen to patients and help them record their wishes.
 
Advance planning directives filed at one Intermountain facility become part of your electronic medical record and are available at all Intermountain facilities. You can submit an advance directive at any Intermountain medical records department or by mail, email, or fax. For information, check www.Intermountainhealthcare.org/advanceplanning. The website also includes extensive information on advance care planning, sample forms, and tips on how to start the conversation as you communicate your wishes to your family.