Has COVID-19 Made You Re-think Your Health Care Directive?

The coronavirus pandemic forces each individual to assess their values and priorities, and overall health. The little COVID-19 clinical information relating to treatment options and likely outcomes based on personal health history should lead all of us to the same conclusion; hope for the best, be prepared for the worst. If you have a medical directive, it is imperative to review it and make additions in light of the coronavirus pandemic. If you do not have one, it is past time to create it. An advance medical directive makes life decisions for you when you are no longer capable. There are four types of medical directives, but all pertain to your medical treatment preferences and a surrogate decision-maker on your behalf to address concerns not already identified in the directive. This legal document is crucial to have if you become incapacitated due to a serious illness, like COVID-19, or an injury.

The most common types of advance directives are the durable power of attorney for health care (also known as the medical power of attorney) and the living will. The two less common directives are Physician Orders for Life-Sustaining Treatment (POLST) and Do Not Resuscitate orders (DNR). Advance directive requirements and forms vary from state to state, so if you have moved, be sure your directive reflects the state in which you live. Before you create your advance directive, it is important to talk with your loved ones, health care provider and identify at least one person to act as your proxy or agent, in essence, your substitute decision-maker. Proactively having these conversations removes the stress placed on families in the difficult position of making the best decisions for their loved ones in the moment of a crisis. Associate professor at USC Leonard Davis School of Gerontology Dr. Susan Enguídanos says, "an advance directive is the best gift that a parent can give their children."

Forbes's interview with Dr. Enguídanos further reveals she witnesses two common misconceptions that stop people from filling out their advance directives. The first is the fear of losing control over decision making once a healthcare proxy or healthcare power of attorney is named. The reality is you will continue to make independent decisions until such a time when you are unable to speak for yourself. Only then will these named individuals step in to make sure your wishes are honored. The second is the fear of the finality of composing an advance directive. An advance health care directive, like a will, can be changed or modified at any time. For instance, many people add a COVID-19 addendum relating to the disease's specific treatment options and then plan on deleting the addition upon receiving the vaccine.

If you have trouble broaching the topic with your children or conversely feel your aging parents should start the conversation about end of life health care wishes, COVID-19 is the catalyst to begin. The Conversation Project, a public engagement initiative to "help everyone talk about their wishes for care through the end of life, so those wishes can be understood and respected," is a good place to begin when you don't know how to start. Senior director of The Conversation Project Kate DeBartolo states, "We can't control how this pandemic will play out, but we can control who will speak for us if we can't speak for ourselves."

Other resources, including an End of Life Decision Guide Toolkit in English and Spanish, are available online here through Compassion and Choices, a non-profit organization with the mission to "empower everyone to chart their end-of-life journey." The website outlines steps you need to take to create your plan and also provides additional resource links. There is also specific information that addresses dying in the age of a pandemic because, to be sure, you are not alone in this endeavor. Once you know your vision regarding your healthcare directive, get together with an estate planning or elder law attorney, ensuring the advance directive's documenting is legally correct. Then have the document on file with your medical doctor and be sure your loved ones have a copy or know where you keep one; you can even put one in the glove box of your car. You can then get along with your life, knowing you have done all you can for yourself and those you love.

We can help you prepare a healthcare directive or review one you already have. We welcome the opportunity speak with you! Please contact our office at  302.651.0113.