I am in my 60s and want to do an advance health care directive. I don’t have children but would like my niece and nephew to make health care decisions for me if I am unable. Can I make them both my health care agents? I.M., Danville
A: First, I applaud you for taking the initiative to do an advance health care directive. An advance health care directive (AHCD) is the best way you can ensure that family, friends and health professionals know exactly what type of health care you want if you are unable to speak for yourself.
A large number of Californians know about AHCDs, but most have not put their wishes into writing. A 2012 report from the California HealthCare Foundation shows that while 82 percent of Californians say that it is important to specify their wishes, fewer than 25 percent have actually done so.
An AHCD form can be downloaded free from the California Hospital Association (www.calhospital.org) or Kaiser Permanente (http://mydoctor.
kaiserpermanente.org) along with instructions. The California Medical Association (www.cmanet.org) and Family Caregiver Alliance (www.caregiver.org) also have excellent information that will answer many of your questions about AHCDs.
There are even Jewish advance health care directives developed by the Conservative and Orthodox branches of Judaism. These Jewish AHCDs include provisions that all wishes must be carried out according to Jewish law and customs. You can find a list of them on the Cedars Sinai Hospital website (www.cedars-sinai.edu).
A more recent form, which many people may not be familiar with, is the Physician Order for Life Sustaining Treatment (POLST). A POLST states what kind of medical treatment patients want toward the end of their lives; unlike an AHCD, it must be signed by a doctor and a patient. A POLST does not replace an AHCD, but complements it by helping give patients more control over their end-of-life care. The Coalition for Compassionate Care of California can provide more information and a free form (www.coalitionccc.org).
So, if you can get the forms for free, don’t need to hire a lawyer, and can make sure in advance that you get the health care you want, why don’t more people fill out advance health care directives?
Part of the issue is that medical care and end-of-life issues can be difficult to think about and even more difficult to discuss with family members and friends. And part of the difficulty gets to the heart of your question — who do I choose as my health care agent?
At a recent workshop sponsored by JFCS East Bay and Ashby Village, the presenter, retired lawyer Priscilla Camp related the story of a couple she worked with who were preparing their AHCDs. The wife wanted to appoint her husband as her agent, but when she asked him point blank if he could “pull the plug” on her if necessary, he responded no. Considering what her wishes were for the end of her life, it became clear that she needed to choose a different agent.
While it is permissible to choose two co-agents, it is not recommended. The primary reason for completing an AHCD is to make sure that your wishes are clearly articulated and then carried out. The potential for disagreement between two co-agents could subvert the very reason for completing the AHCD.
My first question to you is why do you want two co-agents? Are you concerned about hurting your niece’s or nephew’s feelings? I would initiate a conversation with them to find out if they understand exactly what your wishes are and if they are comfortable carrying them out. This conversation may help you decide whom to choose or even to choose someone else.
If you are not comfortable taking that approach, then you may want to carefully consider the following factors when deciding who will be your agent: the age of the person; where the person lives (close by or across the state?); whether the person understands the health care system (perhaps being employed as a health care professional?); and how accessible is the person (does he or she have a demanding work schedule? Other family responsibilities? A demanding travel schedule?). Examining each of these issues and then explaining your decision-making process to your niece and nephew will be helpful in determining the best person to represent you.
Once you complete the AHCD, it is important to make copies for your physician, family and friends. You’d be surprised at how many people complete an AHCD, but then forget to let people know where it is located or what it says.
The bottom line is this: While a lot of information is available about advance health care directives, and most people acknowledge how important they are, that doesn’t always translate into getting them done. As encouragement to take the next step, keep in mind that while you can’t control whether or not you get ill, you can control what treatments you receive.
Rob Tufel, MSW, MPH, is director of Adult Services at Jewish Family and Children’s Services of the East Bay. His columns appear regularly in j.’s Seniors supplements. Have any questions about your aging parents? Email firstname.lastname@example.org or call (510) 558-7800 ext. 352.