Salt Lake City, UT -- (ReleaseWire) -- 11/27/2020 --An advance directive is a set of instructions someone prepares in advance of ill health or accident that determines their healthcare wishes regarding medical treatment and who should act as their agent to carry out those wishes should the person be unable to communicate them to a medical provider.
"Every adult over 18 years of age should have an advance directive," said Cathleen Obray, MD, an internist at the Intermountain Healthcare River Road Internal Medicine Clinic. "An advance directive ensures that a persons wishes are honored even when they may be too ill or too injured to express them themselves to their healthcare team."
Another form of advance care planning that complements the advance directive is the POLST (Physician Order for Life Sustaining Treatment). POLST forms are appropriate for individuals with a serious illness or frailty near the end-of-life.
The Utah Advance Directive is a straightforward four page document that can be found here at https://intermountainhealthcare.org/ckr-ext/Dcmnt?ncid=520444045. Most states have similar advance directives.
The first and perhaps most important aspect of the advance directive is the assignment of a healthcare agent. A healthcare agent is someone whom an individual designates to make medical decisions on their behalf if they are unable to communicate those decisions themselves; for example, if a person is severely injured in an accident. A healthcare agent is also sometimes called a healthcare proxy or surrogate or an attorney-in-fact.
"Often times, one's healthcare agent is a spouse, adult child, or parent, but your agent can be any adult of your choosing," said Obray. "Agents don't need to live locally. What is perhaps most important, however, is that whomever you choose to be your agent knows your wishes and will honor them under distress; even if they disagree. Letting your agent - and ideally all of your loved ones - know who your agent will be is also important. This helps ensure that your wishes are honored and that loved ones can be at peace with tough decisions that may need to be made."
"Life is unpredictable," said Dr. Obray. "A motor vehicle accident, head trauma, COVID-induced pneumonia, or even a fall could leave you unable to make decisions about the medical care you receive. An advance directive ensures that if you are unable to clearly communicate your own wishes, that they are still honored. It can alleviate a great burden to family and loved ones to have made these decisions in advance of tragedy or illness."
In preparing to start advance care planning, Dr. Obray suggests individuals start by thinking about what matters most to you and what is important to you. "It can also help to think about experiences you have had with loved ones who have experienced critical illness or been at the end or life. Then have a conversation with someone close to you about your goals of care should you become seriously ill or injured. What makes life worth living for you? What situations would you find unacceptable? Thinking about your goals of care, sharing your wishes with your loved ones, and designating someone to carry out your wishes, are all part of advance care planning. These conversations are not about death, they are about quality of life."
Advance directive documents can be updated and/or changed at any time and they ONLY go into effect if an individual is unable to communicate their wishes. It is recommended that advance directives be reviewed annually and updated if in case an individual experiences divorce, receives a new diagnosis, physical or cognitive health deteriorates, or if they experience the death of a close friend or family member (including their agent). All of these circumstances can impact how an individual feels about medical treatment, what they may want, and who the best person is to be a healthcare agent. For people over age 65, review of goals of care and an advance directive is a recommended component of the Annual Wellness Visit with one's primary care provider.
"It is important to keep a copy at home but also to provide a copy to your healthcare provider and local hospital," said Dr. Obray. "For anyone living in Utah, we recommend providing Intermountain Healthcare with a completed copy to be stored with your electronic medical record. This way it will be readily assessable if you find yourself in the emergency room and unable to communicate your healthcare wishes."
Dr. Obray also suggests having an advance care planning conversation with a professional. There is a free service provided by the Intermountain LiVe Well Center at Dixie Regional Medical Center, and well as many other free community resources. In Utah, call 435-251-3793 to schedule a conversation or for more information. Nationally you can diall 2-1-1. Advance directive document forms can be found at: https://intermountainhealthcare.org/ckr-ext/Dcmnt?ncid=520444045.
"Advance directives are about providing the right care, in the right way, to the right person, at the right time," said Obray. "It's never too early, until it's too late to make an advance plan for your future medical care."
About Intermountain Healthcare
Intermountain Healthcare is a not-for-profit system of 24 hospitals, 215 clinics, a Medical Group with 2,500 employed physicians and advanced practice clinicians, a health insurance company called SelectHealth, and other health services in Idaho, Utah, and Nevada. Intermountain is widely recognized as a leader in transforming healthcare by using evidence-based best practices to consistently deliver high-quality outcomes and sustainable costs. For more information, see intermountainhealthcare.org.