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Saturday, March 6, 2010

Personal Directives - what decisions will you have to make?

A Personal Directive is a document that appoints someone (known as the Agent) to articulate your health-care and personal decisions for you if you can no longer do that for yourself. In other places, a Personal Directive is called a Health Care Directive, Health Care Proxy or Advance Directive.

I find that these documents are not particularly well known or well understood by people who have had no direct contact with them. A common misunderstanding is that if you are named as the Agent, you could have to decide whether or not to end life support for the person who named you. That isn't quite true.

The idea of naming an Agent is to name a spokesperson. That's not the same as naming a decision-maker. A spokesperson speaks up for you based on what they know about your wishes and beliefs. Your Personal Directive should contain some guidance for your Agent about the end-of-life decision; you should express your feelings about "heroic measures" and artificial life support. Then, if you are ever in that situation, your Agent will have your words in front of him or her to rely on.

This is not to say that your Agent will never have to make any decisions for you. For example, if you were to be admitted to a hospital in critical condition, your Agent might be asked whether you should have blood transfusions, surgery or treatment. He or she might be asked whether you should have a private or semi-private room or other administrative matters. But all of these decisions should be made within the framework of what your Agent knows about your wishes.

If your wishes are "I want absolutely everything done that might help keep me alive", your Agent might make different decisions than if your wishes are "I don't want to be kept alive by any artificial means".

Obviously the key to making this work properly is communication (isn't that the answer to almost everything?). When you make a Personal Directive, talk to your Agent and tell him or her how you feel about being kept alive artificially, quality of life, and organ donation. If someone appoints you as their agent, don't accept the appointment without the opportunity to ask these questions.

Yes, these are really tough questions. I've had to hand plenty of clients tissues during our meetings when these topics are covered. But the whole point of making the Personal Directive is to ensure that should your time for the end-of-life question ever arise, the person speaking for you is stating your wishes.

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