People who are aging or ill often need a trusted other, a Medical Advocate, to speak for them when the person cannot well-represent their own values and wishes. To be hospitalized, or traumatized by pain, or confused by medication or dementia, can prevent us from speaking clearly for ourselves. Before those circumstances happen, it is vital that we correctly create the documents, the Advance Directives, that state our wishes, our values, and our choices of whom we trust to speak for us should we not be able to speak and act for ourselves.
“Betty” – photo by Chris Belding
It can be a daunting process to create our own Advance Directives, but there is a lot of help out there for us. Joining or creating a proactive aging circle is the best way to gather courage and support for all the issues of aging. (See A Harvest of Years to learn about such Circles.)
As I have worked among the elders of our society in their homes, in hospitals, in nursing homes, and in homeless shelters, my own aging and mortality have taken up more and more of my thoughts. Often this is what it sounds like:
These changes that I notice in my body – do they mean I am already old – or is there still time to prepare for my aging? Who will care about me when I am old? What will happen when I can’t care for myself? Will I still have my mind? Please, God, let me still have my mind. And what if I actually DO live to be 100?
And it sounds like this:
Who cares about who I have been, who I am now, and who I am becoming? Who shares my interests? Who inspires me? Who listens to my story, honors my history, and invites me into their story? Now that my family is scattered/preoccupied/gone, who feels like “kin” to me? How can I pass on the wisdom I’ve accumulated through my life’s experiences?*
I became an advocate of proactive aging when those kinds of questions roused me in the night, and when I discovered that I’m not alone in my concerns. I realized that I yearned not so much for answers, but for a way to explore my concerns out loud, in a circle of people who could listen deeply, who could hold and honor my deepest questions. These questions were explored in Circle of Caring, an organization I helped to found when I moved to Whidbey Island, WA. Read an article in the Seattle Times on Circle of Caring.
*(From A Harvest of Years ©2004, 2010 by Cynthia Trenshaw and PeerSpirit, Inc. Available now as an book, “The Circle Way for Proactive Aging: A Harvest of Years” – [The Circle Way Booklets Book 4), an ebook available at https://www.amazon.com/Circle-Way-Proactive-Aging-Booklets-ebook/dp/B01JMQ6URO]
Medical Advocate
A Medical Advocate is a person who may accompany us to medical appointments, helps us to understand what is being said about our healthcare, helps us to think through our decisions, advocates for us within the medical system by knowing our values and wishes and seeing that physicians and hospital staff understand what their patient wants and doesn’t want. This relationship is usually formalized through a legal document called a Durable Power of Attorney for Healthcare.
Advance Directives
Should one become physically or mentally incapacitated in the future, the most certain way for healthcare to be handled in the ways we would have chosen for ourselves, and to avoid a Court-established guardianship in which our personal and civil rights may be lost, is to complete documents called Advance Directives.
These documents include a Durable Power of Attorney for Healthcare, a Durable Power of Attorney for Financial Decisions, a Healthcare Directive, a Life Values Declaration, a Physician-Ordered Life-Sustaining Treatment (POLST) form, and a Will.
The POLST form is an at-a-glance document recognized and honored by paramedics, hospitals, emergency rooms and nursing homes, stating your do/do-not resuscitate orders and other emergency orders. This document must be discussed with and signed by a physician. In my opinion it is the single most-valuable Advance Directive you can create. POLST is available and recognized in Washington, Oregon, Pennsylvania, West Virginia, California, Utah, and several other states. Check online to see whether your state has a POLST program. Some states are in the process of developing POLST, and in the meantime they may have Do Not Resuscitate forms to prevent the violence and futility of resuscitation attempts, particularly on the elderly.
The Durable Power of Attorney for Healthcare, a Healthcare Directive and/or a Life Values Declaration can be composed and distributed by you, with advice from any source familiar with the purposes and the practicable language that will accomplish what you intend. [see below for a List of Resources]
The Durable Power of Attorney for Financial Decisions and your Will is best discussed with an attorney, especially if you have a complex estate. But don’t let that make you put off creating the other documents on your own.
Please do NOT wait until “someday when you’re old” to create these documents. That day may be painfully too late. Even people in their 30’s or younger should have made these arrangements for their futures. All such documents can be altered or revoked as life circumstances change, but they cannot be created after your capacity is compromised.
Advance Directives Resources:
Six excellent resources to help you get the job done
American Bar Association – Consumer’s Tool Kit for Heal Care Advance Planning
http://www.abanet.org/aging/toolkit/home.html
Caring Conversations
http://www.practicalbioethics.org/documents/caring-conversations/Caring-Conversations.pdf
Making Medical Decisions for Someone Else
http://www.americanbar.org/groups/law_aging/resources/health_care_decision_making.html
Five Wishes
http://www.agingwithdignity.org/five-wishes.php
Compassion & Choices
http://www.compassionwa.org/directives.html
Good[end of]Life – Judy Johnson
http://www.goodendoflife.com/