Joan Rivers’ death has people talking about advance directives
The passing of comedienne, Joan Rivers, who suffered cardiac and respiratory arrest after a minor outpatient procedure, was placed on life support and died shortly thereafter, has left many wondering, “could this happen to me?” And, if so, do I have my wishes in order?
Only about one-third of adults have an advance directive expressing their wishes for end-of-life care, according to Pew 2006, AARP 2008. Among those 60 years of age and older, that number rises to about half of older adults completing a directive.
One medical expert says that advance care plans can be developed at any time, whether you are sick or well.
“Once you are sick and disabled with a progressive illness that will last until death, you really need a comprehensive care plan that considers your social supports, your preferences, and your likely course,” said Dr. Joanne Lynn, a geriatrician and hospice physician who heads the Center on Elder Care and Advanced Illness for the Altarum Institute.
She also warns that advance care planning is not just for older adults approaching the end of their lives. It is about planning for the “what ifs” that may occur across the entire lifespan, at any age.
Dr. Roman Kozyckyj, physician advisor to palliative care at Advocate Christ Medical Center in Oak Lawn, Ill., encourages people of all ages to think about the medical care they want in the event of a serious or catastrophic illness or injury.
“You may suddenly find yourself unable to indicate your wishes, and then someone else is put in the position of making decisions regarding your medical care,” Dr. Kozyckyj says. “It’s important that you designate someone and give them specific instructions about what you want so they can communicate your wishes to the health care professionals who may be caring for you.”
Discussion of advance directives is often something that most people shy from and consider taboo. However, palliative care experts like Amy Scheu, administrator for hospice and palliative care for Advocate Health Care in Downers Grove, Ill., say the topic needs to be brought to the forefront.
“You should always prepare for the best, but expect the worst,” Scheu says. “Advance directives should not be considered a morbid topic, but a key topic of discussion that benefits everyone.”
Scheu briefly outlines three reasons why advance care planning is important:
- It helps align patient goals (choices) and wishes with available care options.
- When patients are informed about their options, they tend to make realistic choices in line with appropriate resource use.
- An advance care planning conversation is usually a first step in palliative care interventions. (Palliative care is specialized medical care for people with serious illnesses.)
Keep in mind that if you are going in for a major or minor procedure you prepare an advance directive or a document that denotes someone to carry out your wishes, in the event you are unable to speak for yourself. Dr. Kozyckyj says, importantly, it doesn’t take much time to put a document like this in place.
To learn more about advance directives, visit the Conversation Project, a site dedicated to helping people talk about their wishes for end-of-life care.
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