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Chapter 6: Why do you need an Advance Health Care Directive?

doctor holding the hand of her client

Many of us remember the tragic case of Terri Schiavo.  Terri died in 2005 at the age of 41, having spent the previous 14 years of her life in a persistent vegetative state.  During that period, her husband petitioned the Florida courts numerous times to have her feeding tube removed, believing that Terri would not have wanted to continue living this way.  Her parents bitterly disagreed and contested each court action, believing that Terri would have wanted to continue living.  Aside from the legal issues presented in this case, the political ramifications were also significant.  There were interventions by Jeb Bush, Governor of Florida at the time, as well as President George W. Bush.  Emotions ran high across the country, leading to demonstrations, some in favor of the right to die, others proclaiming the right to live.  At the center, though, was a lady who was living in unimaginably devastating circumstances, and nobody knew whether she wished to live or die.

If you were to become incapacitated and unable to make your own healthcare decisions, who will make those decisions for you?  In California, there is no law that directs which of your family members has the right to make medical decisions for you.  In reality, doctors will typically look to your next of kin if there are decisions to be made.  But what if there is a disagreement between, say, your spouse and your children?  The doctors will not adjudicate such a dispute; instead, they will send the family to probate court so that a judge can decide which family member has decision making authority. 

Even where it is clear who will have the authority to make decision on your behalf, that still leaves open the question of what kind of decisions you would want made in various circumstances.  If your wishes are not clearly documented, that leaves your decision maker in the impossible position of having to guess at what kind of treatment you would or would not want.  If, for example, you are in a coma and doctors have stated that it is very unlikely that you will recover and, if you do, you would likely have severe brain damage, what kind of treatment would you want?  Would you want to be kept alive via artificial hydration and nutrition for as long as possible?  Nobody wants to me in a position where they have to make that kind of decision for someone else without any guidance from the patient as to what his or her wishes are.

An advance health care directive gives you the opportunity to choose who will make healthcare decisions for you if you are unable to make them yourself.  It is also a way to document what your wishes would be in various medical scenarios.  You can make it as general or as specific as you wish.  You can state what kind of surgical procedures and medication you would want.  You can list the circumstances in which you would want treatment to be withheld or withdrawn.  Instead of someone trying to guess what you would want, instead you place your decision maker in the position of advocate: advocate for your wishes as set out in the document.

In the current climate where much feels outside of our control, healthcare decision making is one area where it is very much within our power to make our wishes known, and ensure that those wishes are honored.

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