Advance care directives: planning ahead for peace of mind

Some of life’s toughest decisions need to be made under the most difficult of circumstances. This is especially true when it comes to medical care. But if you could, wouldn’t you want to carefully evaluate all of your options ahead of time and, in a calmer setting, make the decision that’s best for you? With a little bit of foresight, an advance care directive can help you do just that.

Our lives can change in the blink of an eye. Though we don’t like to think about it, we all face the risk of suddenly becoming incapacitated as a result of an accident, a severe illness or simply, old age. Consider this scenario: A 55 year-old male suffers a stroke and is rushed to the hospital. He has two adult children from his first marriage, and a minor child with his second partner, whom he has not yet married. As his family members rush to be by his side, they learn that he is unconscious. Doctors inform the family of his condition, available medical options and their potential outcomes, and the decisions that need to be taken. 

But who gets to decide what should be done? His current partner? His adult children? Or his surviving parent? And who can claim to know best what his preferences are? Some family members may want to ease his suffering, while others may wish to put him on life support indefinitely in the hopes that he may someday recover from his medical condition. But is this really what he wants? And potentially adding to his loved ones’ distress, if no signed advance care directive is readily available, some jurisdictions may allow the state to step in and appoint a legal guardian without the family’s consent.

Ensuring your wishes are respected
Much of this confusion can be avoided – or at least mitigated – by setting up an advance care directive. Simply put, an advance care directive is a written document outlining your wishes for future medical care. Should you be unable to communicate or make decisions for yourself due to incapacity, the advance care directive provides doctors with instructions for your medical treatment according to your personal preferences. 

An advance care directive accomplishes four key objectives:

  1. Ensures your wishes are respected
  2. Spares your loved ones from the burden of having to make difficult decisions during an emotionally stressful time – so that they can focus on coming to terms with the situation, nursing you back to health or providing you with comfort
  3. Reduces conflict should different family members disagree on the best course of action
  4. Ensures that a trusted appointee, rather than a stranger appointed by the state, makes medical decisions on your behalf

Identify your healthcare priorities
Before you begin, it is worth taking some time to reflect on your personal priorities when it comes to making your own healthcare decisions. Some of the questions you may ask yourself include: 

  • What does quality of life mean to me?
  • What types of life saving or life prolonging measures am I comfortable with – and which ones would I like to avoid?
  • What types of side-effects am I willing to endure to prolong my life?
  • How do I feel about pain management?
  • Am I OK with an assisted living arrangement if it becomes necessary?
  • Would I like to become an organ donor?
  • Who would I want to make decisions on my behalf when I can no longer speak for myself?

These are all difficult choices, but you do not have to make them alone. Your doctor can help you understand the treatment options available to you – and their implications – for various medical scenarios. Your doctor will also be able to advise you on how your current health condition might influence the type of medical choices you may need to make in the future.

Enlist the help of a specialist
Once you have identified your personal treatment preferences, and as soon as you feel comfortable enough to begin documenting your wishes, your Relationship Manager along with one of our Wealth Planning specialists can walk you through the steps of setting up the advance care directive. By listening to your needs and concerns with compassion, tact and discretion, they can ensure that the document accurately reflects how you would like your medical team to administer treatment. Our experts will also help you navigate all the technicalities associated with drawing up an advance care directive: everything from making sure that it is properly drafted, to having it signed, authenticated and registered with the appropriate authorities in accordance with the local regulations in your jurisdiction.

Determine the scope
The scope of the directive may be as broad or as limited as you wish. The document itself can be short and concise, focusing only on the types of medical interventions you wish to avoid. But it can also explicitly spell out detailed instructions for a range of potential medical scenarios. 

Appoint a trusted decision-maker
It is almost impossible to anticipate all possible types of medical treatment you might need someday. Therefore, it is also a good idea to appoint someone who can convey your wishes to medical staff and take decisions on your behalf for any medical situations that are not covered by your advance care directive. 

Your personal circumstances and overall health will most likely evolve over time. Therefore, as your priorities shift – or if you simply change your mind – you can amend or revoke your directive at any time as long as your judgment is not impaired.

Talk to your loved ones
Have an open and frank discussion with your loved ones. You can either do this while you are in the process of reflecting on what’s most important to you, or once your directive is already in place. Talk about your primary medical concerns. Discuss your fears. Tell them what your non-negotiables are. Initially, this may seem like an uncomfortable conversation, but in the long-run it will help ensure that your loved ones also understand your wishes and can advocate on your behalf.

Because your directive will only serve its purpose if your medical team is aware of its existence, it is also important to inform your loved ones and your primary care physician that you have set up an advance care directive. Tell them what’s in it and where they can find it in case of an emergency. Another option is to entrust the document to your appointee.

Medical care on your own terms
Certain topics understandably make us uncomfortable. Given our discomfort with facing our own fragility, many of us put off expressing our healthcare preferences in writing. But it is never too early to start. Once you overcome – or at least temporarily set aside – those fears, establishing an advance care directive can provide you and your loved ones with the peace of mind that you will receive the medical care you require, on your own terms. 

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