Doctor Urges Medical Advance Directive as Beneficial, though Need Is Unlikely

virtually no patients have medical advance directives ready, doctor says

By Jonny Lupsha, Wondrium Staff Writer

In an op-ed for The Huffington Post, a COVID-19 unit doctor said death is unlikely, but better to be safe than sorry and have medical paperwork in order. She said that families almost never discuss emergencies beforehand. If you want to prepare documentation, here’s where to start.

Elder couple viewing documents together
Seldom do families discuss medical advance directives before emergencies, although it is best to prepare them before they are needed. Photo by fizkes / Shutterstock

Independently-tracked global and national statistics on coronavirus from the top-ranked organization Worldometers paint a clear and positive picture: the vast majority of people experiencing COVID-19 infection do recover and cases do not end with mortality. However, enough cases have ended in death to prompt Dr. Asha Shajahan to tell The Huffington Post that she wishes her patients would have end-of-life discussions with their families and prepare medical advance directives just to prevent future uncertainties for their loved ones about what their final wishes would be and under what circumstances.

“While we are social distancing in our homes, it’s time to have that conversation most of us have avoided—or didn’t know we needed to have,” Dr. Shajahan said. “Make an end-of-life plan, write it down, and have it available to discuss with your doctor.”

If you think preparing a medical advance directive would be a good idea, here are some tips to understand it a bit more.

Why Do Advance Directives Exist?

“Medical ethics require that doctors get consent before they can treat you, except in emergencies,” said Sally Hurme, J.D., law expert and author. “Other than these life-saving measures in an emergency, many other decisions need to be made about your medical care. You make those decisions and provide the required consent every time you decide to get a flu shot, have the dentist fill a cavity, go under anesthesia, or have your blood drawn.”

Sometimes a patient is eligible to receive non-emergency treatments, but cannot clearly give their consent for one reason or another. Hurme gave examples like being unconscious, disoriented, or lucid but still unable to communicate for some reason. In the medical world, obtaining consent is still important, ethically, so what do patients and doctors do so as not to violate the patient’s wishes but still provide the best care? The answer is advance care planning.

“There are three essential steps,” Hurme said. “First, you have to think about what treatments and health care you do or do not want; [second] communicate your thoughts to those you want to make decisions on your behalf; and finally, you put down those wishes on a piece of paper in the appropriate legal forms.”

These legal forms, she added, are called advance directives.

Properly Obtaining Power of Attorney

In all 50 states, a member of the public can sign an advance directive granting someone the right to represent their medical wishes in case of such an event. These representatives are called health care agents, proxies, or surrogates, and they’re elected by granting them power of attorney, just like in the financial world.

“That person, as your agent, must follow your instructions and only has the authority to do what you put in writing, and your agent can start making decisions only when you have specified when this power begins,” Hurme said. “So long as you can provide your own consent, you do so. Your agent can’t do anything, make any decisions, unless and until you become unable.”

Hurme mentioned three specific components involved to a health care power of attorney. First, you must identify that person in writing who you wish to make decisions for you. Second, you set down any “guidance or instructions” you wish for them to follow. Third, you specify that you grant them the authority to receive and review your health information as needed in order to make the decisions you want.

In drawing up this document, clarity is key. “To be on the safe side, it’s good to include language specifying that you want your agent to have access to all your medical records to get around any HIPAA [Health Insurance Portability and Accountability Act] privacy regulations,” Hurme said.

Finally, choosing a health care agent should be a decision one makes carefully, as Hurme mentioned it is neither honorary nor easy. She recommended assigning someone smart and responsible who you know well and whose judgment you trust.

As unpleasant as end-of-life discussions can be, and as unlikely as it seems that they’ll be necessary, it may be a good idea to have advance directives prepared. After all, better safe than sorry.

Sally Balch Hurme, J.D., contributed to this article. Hurme is an elder law expert and author who has led the national conversation on many of the legal issues of concern to older persons and their families. She received her B.A. in Political Science from Newcomb College of Tulane University and her J.D. from the American University Washington College of Law.