Hospice Tips for Clinicians

A monthly tip sheet from Regional Hospice

Volume 1, Issue 3 March, 2012

About Advance Directives

Author: Eric Warm, MD

Written advance directives are legal in every state. Laws
and forms, however vary from state to state. There are two
general types of advance directives:

• Health care power of attorney is a document
  in which the patient appoints someone to make
  decisions about his/her medical care if he/she
  can’t make these decisions.
• Living will is a written document in which a
  patient’s wishes regarding the administration of
  medical treatment are described if the patient
  becomes unable to communicate at the end of life.
  Some documents are the combination of the two.

The following are some common misunderstandings
that create barriers to properly complete and implement
advance directives.

1. Many physicians believe it is not appropriate to
   begin advance directive planning on an outpatient
   basis. In reality multiple studies have shown that
   patients want their doctors to discuss advance
   care planning with them before they become ill.
   Overcoming this barrier: When beginning a
   discussion of advance directives simply ask, “Do
   you know what an advance directive is? Do
   you have one?” A patient may respond by
   saying, “why is there something wrong with me?”
   They can be reassured this is a question asked of
   all patients.
2. Many people believe that if a loved one has
   financial power of attorney he/she doesn’t need
   a separate medical power of attorney. This is
   not true. Most often these are separate legal
   documents.
   Overcoming this barrier:
   When discussing “Power of Attorney” with your patient,
   assess his/her understanding. Have literature
   available to clear up discrepancies.
3. Many physicians and patients feel that having
   an advance directive means “don’t treat.”
   Unfortunately advance directives can be a trigger
   for disengagement by medical staff.
   Overcoming this barrier: Make sure your patient
   and staff understand that advance directives don’t
   mean “don’t treat me.” They mean, “treat me the
   way I want to be treated.”
4. Patients often fear that once a person names a
   proxy in an advance directive they lose control of
   their own care.
   Overcoming this barrier: When explaining
   advance directives to your patients, make sure
   they understand that as long as they retain
   decision making capacity, they retain control of
   their medical destiny.
5. Many people believe only old people need
   advance directives.
   Overcoming this barrier: The stakes may
   actually be higher for younger people if tragedy
   strikes. Use the example of the Terry Schiavo
   case as a trigger to enlighten the discussion.

   
   
   References:
   1. Atkin PV. Incorporating advance care planning into
   family practice. American
   Family Physician. 1999,59(3): 605-14, 617-20
   2. The Support Principle Investigators.
   3. American Bar Association.

Regional Hospice
We’re here when you need us.

Medical Director: Dr. Jeff Lewis
715-779-3703
___________________________

Nursing Director: Lynda Anderson
715-685-5151
___________________________

Executive Director: Joe Muench
715-685-5151
Email: jmuench@regionalhospice.org

Ashland Office:
715-685-5151

Hayward Office:
715-634-6433

Spooner/Grantsburg Office
715-635-9077