Over 60% of all U.S. deaths are due to either heart disease, cancer, diabetes or chronic obstructive pulmonary disorder.
In addition, more than 40% of Medicare enrollees over 65 years of age face physical or cognitive challenges.
As each of us gets older, two truths become an ever-growing reality.
First, we are going to have limitations and need help as we age. Second, one day we will eventually die.
Both of these are unavoidable and should involve planning. Yet, these matters are seldom discussed among families.
We know that one day we will need to make end of life decisions, but most of us never put anything down on paper.
A 2018 survey by The Conversation Project revealed that 92% of people think it is important to talk about end-of-life issues but only around 32% have ever had the discussion.
In 2017, The Kaiser Family Foundation reported that 96% of seniors thought it was important to put wishes in writing but only around 25% had actually discussed it with their physicians.
Therefore, National Healthcare Decision Day (NHDD) was created in 2008 by health care lawyer Nathan Kottkamp for the purpose of promoting and providing concise and easy to use information about advance care planning.
Since 2016, The Conversation Project has overseen the funding and management of the annual observance. NHDD, which occurs every April 16, is an opportunity for each of us to be proactive and make decisions about what will happen to us.
NHDD can be a time for each of us to sit down and not only tell our love ones what we want if the unthinkable happens but also to put those wishes in writing.
Several national organizations provide easy to access information about advanced care planning.
The Conversation Project provides a treasure trove of information.
The Five Wishes document addresses basic questions, ranging from who should make your end-of-life decisions to what you want to happen with your remains.
Even AARP provides a link to information about the advance directive laws, complete with forms, for most U.S. states.
In addition, every U.S. hospital that receives Medicare or Medicaid funding is required to assist patients in completing and documenting advanced care plans.
With the ease of acquiring information on advance care planning, we are left with two questions.
First, what do we need to document?
As someone who meets with families in intensive care daily, I can unequivocally say the most important consideration is to determine who is going to make your decisions. I honestly think this is scarier to determine than where you will be buried.
Part of human nature is to be autonomous. We do not want people making decisions for us. Yet, if something happens to you such that you lose decision-making capacity, then someone will have to make your decisions.
Most states have rules for how a surrogate health care decision maker is appointed. Unless you are proactive, the person a hospital appoints may not be who you would pick or who knows you best.
You also need to document what you would, or would not, want during a health care emergency.
This is a more complicated question, as the state of medicine is ever evolving.
New technologies are coming online every week. It is impossible to foresee every new medical advancement, but it is important to give loved ones and healthcare providers a general idea of what you would or would not want.
Would you want to be on a ventilator permanently? If you had a terminal diagnosis, would you want cardiopulmonary resuscitation? What are your thoughts about hospice?
Documentation should be generalized in order to be applicable to a host of medical emergencies.
Another area of concern is issues surrounding death. Who do you want to be in the room with you as you die? Who needs to know about your passing?
Often forgotten is the possibility of organ, tissue or eye donation. Donate Life America enables individuals to register for organ donation.
If a patient is eligible for organ, tissue or eye donation and they are not registered, then their family will be asked to make a decision.
Frequently, I have seen families decline donation simply because they had already made 10 difficult decisions and could not make another. Later, they regretted saying no, since their loved one would have wanted to donate.
Donation deserves a serious consideration since an organ donor can save up to eight lives and enhance countless others through eye and tissue donation.
Still another area is whether you want to be buried or cremated and where you will be interred. Most funeral homes have the option to pre-arrange your funeral.
The second major question is, why even bother documenting your wishes?
The answer is simple. It is the loving thing to do.
Over the last 15 years in health care, I have spent countless hours assisting families in making painful decisions that could have been discussed and made in advance.
Making end of life decisions for another person is stressful. I meet families, years after their loved one’s death, who are still wrestling with whether they made the right decisions.
When a family can tell me what their loved one wants, it is easier and the burden of making a decision is not there.
At the time of death, there are lots of unforeseen decisions and the pain of grief slows the mind’s ability to process.
Any decisions that we can make in advance frees our loved ones from unnecessary emotional burdens, giving them the ability to focus upon what is important: the relationship we have with each other.
Senior Staff Chaplain and Clinical Ethicist at the Baptist Health Medical Center in Little Rock, Arkansas.
