Because life is uncertain, there may come a time when you are unable to discuss your wishes when it comes to end-of-life decisions. Without an advance directive, things can be much harder for loved ones to know what to do.

An advance directive is a written statement regarding your wishes for medical treatment if you are unable to speak for yourself because of a serious illness or injury. It may include the fact that you want every life-saving measure to take place or you simply wish not to be resuscitated.

“When instructions are not clear from the patient, our health care systems have a default setting and the default setting is very aggressive treatment,” said Dr. Dominic Moore, medical director of palliative care for Intermountain Healthcare. “That can mean a ventilating machine, other life support machines, CPR, chest compressions, attempts to shock and restart the heart.”

Saturday, April 16, is National Healthcare Decisions Day and physicians from all over the state are asking Utahns to take the time to fill out an advance directive and give it to their hospital, doctor, family members and other loved ones.

“Over the past 20 plus years, I’ve talked to patients about end of life from all different ages,” said MountainStar Healthcare physician Dr. Steve Cherrington. “I see a lot of hurt when an advance directive is not done and there can be a lot of grief on the part of the families who are left behind who were not able to answer those questions.”

Cherrington said as difficult as it may be, everyone should discuss their end-of-life wishes, such as who they want to speak for them if they are unable to do so themselves and what end of life looks like for them. He said there are three basic categories that typically take place when discussing end-of-life care. The first category is low stress and takes place when an advance directive is discussed early on. The second category is heightened stress and occurs when the topic is discussed after a possible terminal diagnosis. The third category is very high stress and occurs when a patient is so sick they’re unable to make their own decisions.

“If they have drafted their wishes into an advance directive, it can be so helpful and the family can feel good about the decisions they’ve made,” he said.

Dr. Kencee Graves, associate chief medical officer for inpatient health at University of Utah Health, said even though the conversation may be uncomfortable, it is critically important to have, and it’s ideal to have that conversation at home with your loved ones.

“You can start by saying, ‘Mom, Dad, whoever, I know this is hard to think about, but it’s really important to me to honor your wishes. If you can’t speak for yourself, who should act on your voice? Would you want your life prolonged by machines,'” she said. “It’s so important to know what quality of life is for them, what makes us us and what constituted a happy, healthy life. Try to have those conversations now.”

Moore, who treats a lot of children in his practice, said if the child is under the age of 18, the decision falls on the parent. However, the child should still have the opportunity to voice their opinion.

Dr. Arlen Jarrett, chief medical officer for Steward Healthcare, said every state has a website to find an advance directive as well as plenty of resources to help during the process.

“Most people do not make advanced plans and studies have shown how difficult it is for patients and doctors to make these decisions,” he said. “We survey every patient at the time they register and provide assistance to those who haven’t made plans. Without an advance directive, people may not receive the outcome they hoped for. That’s why we want to shine a light on the issue and point people to the resources available.”

To find a form, go to ucoa.utah.edu.

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