Advance Healthcare Directives

An Advance Directive for Healthcare is a document used to communicate your wishes about end of life treatment, if you are unable to make your own decisions. If you are able to communicate your wishes regarding any medical treatment, then that communication trumps anything you have written in your Advance Directive. However, when you are unable to communicate your wishes, then your agent makes those decisions based on the information you have provided in the Advance Directive.

Thinking about end of life treatments means thinking about your values. What gives your life meaning? If you could no longer do the things that give your life meaning, what medical treatment or non-treatment is right for you? There are several excellent free resources available linked at the bottom of this section to help guide you through those decisions, and to help you have a conversation with your family about end of life treatment. It is crucial to discuss your wishes with your family and help them understand your decisions. There have been times in our practice that the healthcare agent did not follow a parent’s wishes “because Momma didn’t really mean to check that box.”

In order to avoid that outcome in our community, we are part of a pilot program called “Conversation Ready.” Dr. Greg Phelps, a hospice physician explains: “the Knoxville Academy of Medicine (KAM) Foundation has enrolled as a pilot site in one of 23 states across the US where the Institute for Healthcare Improvement is engaging in Conversation Ready. The collaborative project involves area hospitals, providers and other institutions.” The focus of this project is educating the medical community and families to have conversations about their values and how their values relate to end of life care. The KAM is working with other stakeholders, such as the Tennessee End of Life Partnership (TELP) to educate the medical community and the community as a whole about this crucial conversation.

At what age should a person sign an Advance Directive?

A young adult should sign an Advance Directive as soon as he turns 18. Remember that Karen Quinlan, Nancy Cruzan and Terri Schiavo were young women who did not have Advance Directives and each of them was in a persistent vegetative state. The controversy over allowing machines and/or a feeding tube to be removed from these young women wound its way through our court system and the press. That outcome could have been avoided if these young women had a written Advance Directive for Healthcare.

If a patient does not have an Advance Directive, and if the patient lacks capacity to make reasoned healthcare decisions, then Tennessee law provides that a doctor may choose a “Healthcare Surrogate.” The doctor will complete a form appointing the person, based on several statutory factors, and then the Surrogate makes the end-of life decisions. Tennessee law also provides that if there is no one to make healthcare decisions for the patient, then the doctor, with the approval of two other physicians and in consultation with a medical ethicist, may serve as the healthcare surrogate. However, if the family does not agree with the choice of the Surrogate or does not agree with the Surrogate’s decisions, then the family may petition the Chancery Court to appoint a Conservator of the person to make healthcare decisions for the patient.

At Franklin & Kyle Elder Law, we educate our clients about healthcare and end of life choices. Our Healthcare Advance Directive has educational information and options for a client who suffers or may suffer from dementia. The healthcare community tells us that 49% of people over the age of eighty have dementia, and with each additional birthday, the risk continues to rise. Dementia is not a normal part of health aging. However, we must plan for the possibility of suffering from this devastating illness as we age.

In order to assure our client that her wishes will be honored, we advise that the appointed agent for healthcare decisions sign our client’s Healthcare Advance Directive, acknowledging that she will carry out our client’s wishes, and that the agent and the client have discussed the options chosen and our client’s reasons for making those choices. Making difficult decisions is made easier when the agent feels reassured by the knowledge that she is doing exactly what our client has requested. We also encourage our client to discuss her values with the rest of her family so that the risk of misunderstandings or conflict will be diminished when it is time for the agent to act.

Links to other pages regarding end of life decisions:

Dr. Phelps describes our community’s participation in the collaborative project called “Conversation Ready.”

The Conversation Project is dedicated to helping people talk about their wishes for care at the end of life.

National Healthcare Decisions Day is April 16, and the Conversation Project website has put together a list of resources regarding Healthcare Advance Directives.

Physicians Orders for Life Sustaining Treatment Paradigm is an approach to end of life planning based on conversations between patients, their loved ones and healthcare professionals designed to ensure that seriously ill or frail patients can choose the treatment they want or do not want and that their wishes are documented and honored.