Talking With Your Parents About Advanced Directives

Talking about the healthcare your parents might choose at the end of their life may not seem like an appealing discussion to have around the Thanksgiving table, but it’s an even more important topic than the quality of mom’s mashed potatoes.

Tony Pfeiffer, the ethics committee co-chair for ProMedica Toledo Hospital and ProMedica Toledo Children’s Hospital, says the end-of-life care conversation should be conducted before it’s needed, which may be too late.

“I really feel that people should address it as early as possible,” he says. “I always encourage people to do it during the holidays when you’re sitting around the Thanksgiving table. It may sound like a taboo topic or a morbid thing to talk about, but when you have everyone together, everyone is consistently hearing the same message.”

In discussing end-of-life matters, there are two advance directives documents to consider: a living will declaration and a healthcare power of attorney.

What is a Living Will?
While the living will — which spells out what you want done if you’re not able to make decisions for yourself — is more commonly referred to, it is often the less powerful of the two documents.

“A living will is limited in that it only goes into effect when in a permanently unconscious state or you’re terminally ill,” says Pfeiffer, noting many individuals may not find themselves in such a situation. Still, the form does allow individuals to be specific on their wishes, Pfeiffer adds.

“You can say, ‘I don’t have a problem being on a ventilator up to the point where they determine I’m unweanable and would need a tracheostomy or something like that, then I want it discontinued,’” he says.

Understanding Power of Attorney
The power of attorney form identifies a primary and secondary agent to direct one’s care if the individual is unable to make their own decisions during the end-of-life period. This agent may be a spouse or child. However, some family members may have a hard time following desired healthcare orders for their loved ones in the hopes of keeping them alive as long as possible, Pfeiffer says. In these cases, a child or spouse may not be the right choice.

“They may want to consider somebody else who they can sit down, have an honest conversation with them, look them in the eye and say, ‘Do you understand what I want? Can you follow this for me?’” Pfeiffer says.

Next Steps After the Important Conversation
Filling out these two documents is simple and free. Copies are available at hospitals or online at the Lucas County Probate Court website. The forms can either be notarized or witnessed by two people not related to the individual through blood, marriage or adoption (nor their primary care physician). Although a legal document, these forms — which go into effect immediately — do not require an attorney or filing into a legal system.

Pfeiffer recommends that primary care physicians and family members should be made aware of the documents’ existence. The forms should be displayed out in the open, where emergency personnel or family can see them if necessary.

“To me, the biggest thing is motivation,” Pfeiffer says. “If you’re not motivated to do it, you’re not going to do it. Perhaps having that conversation starter with your parents is going to be the motivation or catalyst to getting their documents in place so they have a voice moving forward.”