I once asked a simple question to a roomful of young residents I was training: "How many of you have advance medical directives?" Of course, all of them were in their 20s and in good health. No hands were raised and there was a good deal of laughter. I then asked a follow-up question: "How many of you can say with 100 percent certainty that you won't get hit by a bus today?"
No one laughed as I went on to tell those young doctors that advance directives allow you to have options. You get to decide what you want in the event of an accident or catastrophic illness--and you spare your family the burden of making wrenching decisions, unaware of your desires.
Unfortunately, in my time as a practicing physician, I saw the pain and stress families endured when a person had a severe stroke, or was gravely injured in a car accident, and there were no advance directives concerning treatment preferences or who was to make medical decisions.
That's why April 16 should be an important date on our calendars. It's National Healthcare Decisions Day, or NHDD. It's also the date following the day our taxes are due, for as Benjamin Franklin wrote, "In this world, nothing can be said to be certain except death and taxes."
NHDD's chair Nathan Kottkamp says this 50-state annual initiative aims to demystify health care decision-making and help people understand that it's not just a matter of creating a living will--it's a process that should start by having a conversation with family and friends, and choosing a person to carry out your wishes.
While it is an issue that should be considered by all adults, I think it's especially important for anyone living with a chronic, potentially life-limiting disease, whether it's breast cancer, Parkinson's, renal failure or some other condition. Advance directive planning should really be regarded as part of the continuum of care. It is the only concrete way to make sure your wishes are respected if you are unable to speak for yourself.
My own family's experience shows how vital this planning is. After my father's first stroke, he and my mother put together an advance directive. Years later, my father had a massive stroke and my mother, of course, called 911. In the turmoil, the EMTs didn't notice the living will on the refrigerator and before my mother could tell them about it, they had intubated my father's trachea so he could breathe. But because my father had an advance directive and wished to be an organ donor, ultimately we were able to carry out his wishes, keeping him alive long enough to donate his liver, kidneys, and corneas.
As emotional as the entire experience was for my family, it underscored the importance of making one's wishes known in advance. That's why I have a power of attorney for health care, as well as a clear statement of what I want done if, for example, I lose the ability to communicate my wishes. My children know my preferences and now since they are now all young adults, my next job is to get them to think about their own advance directives.
If you haven't thought about advance directives yet, I hope April 16 will spur you to do so. Please remember that once you make your decisions, they are not set in stone. Life circumstances change and your preferences can change as well. Indeed, that's why a key document is called a "living will."
So I urge you to set aside April 16 for a visit to the National Healthcare Decisions Day website at www.nhdd.org. There, under the Resources tab, you will find links to a wealth of information from AARP, the American Bar Association, and other respected organizations to help guide you in developing your own advance directives.
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