Workshops Geared To Clarify Advanced Directives

By Nancy K. Crevier

Linda Pinckney, clinic director at Kevin’s Community Center in Newtown and a hospice nurse, was joined by elder law attorney Paula Boa-Sousa of Collins, Hannafin, Garamella, Jaber and Tuozollo of Danbury and board member of Regional Hospice and Home Care of Western Connecticut, and social worker Carolyn Wolfe, LMSW, at a hands-on workshop on Advance Directives on February 16 at Southbury Senior Center, sponsored by Regional Hospice. “Let’s Talk About Advance Directives” was the first of multiple workshops slated for senior centers in the area, including one coming up at Newtown Senior Center on Friday, April 20, at 1 pm.

According to MedLinePlus, a service of the US National Library of Medicine and the National Institutes of Health, advance directives “are documents that allow you to convey your decisions about end-of-life care ahead of time. They provide a way for you to communicate your wishes to family, friends and health care professionals, and to avoid confusion later on.”

A living will, a health care representative, and the appointment of a conservator are all part of the advance directive. A conservator is assigned if a court hearing is required to determine incapacity, and one has not been previously assigned through an advance directive. That person would then fill the position of determining financial and health care, said Ms Boa-Sousa.

An advance directive, Ms Boa-Sousa said, is used when a person can no longer actively participate in health decisions. It comes into effect when it appears an illness or trauma is terminal, and a person cannot speak for him or herself.

Ms Boa-Sousa said many people do not understand what an advance directive or living will is, and confuse it with a Do Not Resuscitate (DNR) directive.

“A DNR means ‘Don’t touch me. Let what happens, happen.’ That is not the case with living wills. A living will says, ‘Try to keep me alive. But if a machine is living for me, that is not how I want to live. I’m terminal,’” she explained, and states what measures a person wishes be used to extend life.

The advance directive is entirely optional, stressed Ms Pinckney. “It is solely for your benefit, and is never required for treatment,” she said, and explained how health decisions can be made if no advance directive has been prepared.

Health care providers will confer and do their best to provide what they believe to be in the best interest of the patient, and may attempt to contact a patient’s primary care provider if that information is available, but without an advance directive, a doctor does not have to listen to spouses or family members, she said.

For the families, she pointed out, it is much easier if a person’s wishes are known before a crisis.

Using the analogy of a map to explain an advance directive, Ms Wolfe suggested workshop attendees imagine going on a road trip in which you know how you are getting from point A to point B.

“You have a plan. But what if I suddenly can’t drive for some reason? Do I have someone to drive for me, to get me there?” she asked. That backup driver is the advance directive, she said. It assigns a “driver” to follow a person’s end of life plans. It provides a map of what kind of treatment one does or does not want, how much intervention, and who that trusted “driver” is going to be.

The workshop provided participants with a booklet that explained what an advance directive is, and included forms legal in the state of Connecticut that are necessary to fill out an advance directive. Attendees were able to fill out the forms either during the workshop, or later. Those seniors providing a photo ID were able to have Ms Boa-Sousa notarize the power of attorney form on the spot, the only assignation that requires a notarized signature.

The booklet covered many subjects: a person’s rights; the different parts of an advance directive; what is a living will; health care terminology; the difference between a health care representative and a conservator; what kinds of treatment decisions are desired and who makes those decisions; and legal questions concerning advance directives and the assignment of conservators or a person with power of attorney.

Ms Pinckney and Ms Boa-Sousa clarified those issues, going over each section of the booklet during a question and answer period at the workshop.

Once an advance directive has been drawn up, said Ms Pinckney and Ms Boa-Sousa, copies of it should be convenient. Do not store the directive in a bank safe deposit box, where it may not be accessible outside of banking hours.

“Give a copy to your doctor, give one to whomever you assign as your health representative, and keep a copy of it in your home,” Ms Boa-Sousa cautioned.

“Now is the time to do it,” urged Ms Pinckney. “If you can’t speak for yourself, [with an advance directive] your wishes are known and followed for what you want for medical treatment. It puts the family in a hard situation if they don’t know [what your wishes are],” she said, in a conversation prior to the February 16 workshop.

“You never know when you won’t be able to handle your affairs,” agreed Ms Boa-Sousa. “An advance directive allows you to appoint the people that you trust and want [to speak for you when you cannot],” she said.

Both Ms Pinckney and Ms Boa-Sousa stressed the importance of having an advance directive, especially for the elderly and as the risk of dementia increases. But while the spring workshops are focused on senior citizens, Ms Boa-Sousa emphasized that advance directives are not just for the elderly.

“Even if you are in your twenties or thirties, something can happen, at any time. Once you don’t have capacity, for any reason, you can’t assign anyone. If no one is assigned, the case goes to probate court,” she said.

An advance directive gives care providers a means with which to meet a goal. “Care providers,” she said, “strive for comfort and dignity at the end of life.”