Tuesday February 27th, 2024 8:28AM

Advance medical directive: make end-of-life decisions ahead of time

By Joy Holmes Multimedia Journalist

Northeast Georgia Health System has spent this month advocating for the importance of an advance directive for health care, which is a legal document that has allowed people to make their own end-of-life decisions.

“Who would speak for you if you came to our hospital and weren’t able to speak for yourself and would they know how to advocate for what you want or what you don’t want,” Advance Care Planning Team Manager Libby Dunahoo with NGHS said.

The Georgia Advance Directive for Health Care Act was adopted by legislatures in 2007 and combined the former living will and durable power of attorney laws, according to the Georgia Department of Human Resources

The 16-year-old adoption allowed people the freedom to choose the person who would make healthcare decisions for them if they were unable to themselves, also called the healthcare agent. Patients would also decide their medical treatment and care preferences, and direct healthcare professionals on what to do should they be faced with an end-of-life situation, Dunahoo said.

“We need the patients to let us know because they’re the expert of their life and they’re the ones that draw the line for what they want, what means the most to them and what the quality of life is that they want,” she said.

NGHS developed an Advance Care Planning program called “Respecting Choices” to advocate for healthcare decision planning and community awareness. The program is funded by the NGHS Foundation’s Healthy Journey Campaign and is aimed to improve the health and well-being of people in the community, according to NGHS online

The Advance Planning Team has hosted community forums through the Respecting Choices program and has offered private meetings to families who want to learn more about their healthcare choices together. The team is focused on educating and empowering people to have conversations with their loved ones so everyone is on the same page when it comes to end-of-life decisions, Dunahoo said.

“The conversation is more important than the document,” she said. “That’s the place where we find peace with family members that have been able to say ‘Hey, remember when we talked about this all together. We know that mom or dad would have wanted this or would not have wanted this,’ and so that becomes a big piece of this [program], is knowing that the conversation is much broader than just things you put down in a document.”

Advance planning conversations would benefit any loved one who is at least 18 years old, Dunahoo said. She has seen situations where parents had to advocate for an adult child because there was no advance directive; however, that patient may not have necessarily felt their parents would have made an appropriate healthcare agent for them and may have wanted to appoint someone else, she said. 

“We don’t ever try to say the conversation alleviates the difficulties or the pain of looking at what choices are but it is a benefit to do it,” Dunahoo said. “Everybody over 18 could potentially be [admitted into the hospital] and be in a situation that needs life sustaining treatment and anybody should be able to advocate for someone else they love.”

In the absence of an advance directive, the legal hierarchy of Georgia must be followed to appoint a healthcare agent. The order in which people are appointed to make decisions is first the spouse; then, guardian; adult child; parent; adult sibling; grandparent; grandchild; adult niece, nephew, aunt or uncle; and finally, adult friend; However, circumstances have occurred where employers served as healthcare agents to patients, Dunahoo said.   

Whoever has been listed as a healthcare agent in an advance directive needs to be told they were selected to make someone else’s difficult medical decisions. If an accident happened and a patient’s healthcare agent was contacted without knowing they were the patient’s healthcare agent, that person would have the right to refuse responsibility, she said.  

“If we call someone and say ‘Hey, Mrs. Smith is in the hospital and named you as her healthcare agent,’ they can say, ‘I actually didn’t know that. We have never talked about that and I don’t feel comfortable making these decisions,’ so, going back to that conversation.”

NGHS has prepared to serve as mediator to family conversations, but if people wanted to start conversations privately, the health system would provide tools to help ease people into what could be a difficult topic, Dunahoo said. 

Plan in a Can,” an initiative implemented in tandem with the Advance Care Planning Program through Wisdom Project 2030, is a recycling project used to help ease people into difficult conversations. The initiative recycles tennis ball containers and turns them into grab-and-go emergency kits. Cans are meant to house important health information, like advance directives, for unplanned trips to the hospital.

“You can personalize [your can] as much as you want and it goes on top of your refrigerator because that’s where EMTs look for vital information,” Dunahoo said. “[Plan in a Can] helps to be ready in case of emergencies and those what ifs in life, and then opens the conversation for advance directive for healthcare.”

Once an advance directive has been completed, it will need to be reviewed over time and updated if life has changed and affected healthcare decisions. The “Five Ds” are considered a good rule of thumb to follow when it comes to maintaining an advance directive, Dunahoo said.   

"The Five Ds" of an advance directive:

  1. Decade - Documents need to be reviewed every ten years.

  2. Death - If the person named as your healthcare agent died, another agent would need to be named.  

  3. Divorce - If a person has divorced their healthcare agent, another agent would need to be named. If a person married someone other than their healthcare agent, they would need to be renamed.

  4. Diagnosis - When a person has received a new diagnosis or changed diagnosis, they need to talk with their medical team about their goals and treatment preferences.

  5. Decline - Documents need reviewed as there is a notice in declined health. 

For morning information, visit the Northeast Georgia Health System website. Appointments with NGHS officials to discuss advance planning options may be scheduled online. An advance directive may be downloaded and completed at home or with assistance from NGHS advance planning officials. People and businesses interested in hosting an advance planning forum should contact NGHS through its contact form online or by contacting the health system directly.

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