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Plan Early to Give Yourself Peace of Mind

May 10, 2010
5/5/2010 Plan early to give yourself peace of mind Living wills allow for important decisions before crisis strikes By Kimberli Turner Colorado Hometown Weekly While end-of-life decisions can be an uncomfortable topic, having to make them for someone else can be even harder. This is why having an advance directive — a living will — is a good idea, said Dr. Alan Rastrelli, a palliative care doctor with Exempla. These documents make it easier on everyone, he said — the patient, family members and the medical team — if a medical crisis arises. Rastrelli, who works in the palliative care unit at Exempla Good Samaritan in Lafayette and Exempla St. Joseph’s in Denver, works with patients who are suffering from chronic illnesses. A palliative care team is usually made up of five people: a doctor, a chaplain, a nurse, a social worker and a pharmacist. The team attends consultations on end-of-life decisions with palliative care patients. But Rastrelli noted it’s important to have advance directives in place before a crisis arises. “Decision-makers can get an idea what the person would ask for if they can’t make decisions,” he said. Rastrelli said the advance directives have two main components. The first piece includes information naming a medical power of attorney — someone to make decisions for a patient if that person is unable to do so. The document should also contain a living will with details on how a person wishes to be cared for should they be unable to tell someone what they want or need. These details outline if the person wishes to be resuscitated should they stop breathing or, if the person becomes unconscious, if they would like treatments such as a breathing tube or chemotherapy. “The downside is that you can’t imagine every scenario you might be presented with, unless your disease is fairly predictable,” Rastrelli said. Rastrelli said advance directives lessen stress on family members when people make these decisions while they are still healthy. Sometimes, he said, family members of a person without a living will might want different things for the patient. “There might be discord among the family about what their loved one might want,” he said. Rastrelli said people should keep a copy of their advance directive and give copies to their power of attorney, other family members and their primary care doctor. If the person is seeing the palliative care team, a copy of the advance directive is kept with the person’s medical chart, Rastrelli said. In Colorado, a separate document is necessary if 911 has been called and a person wishes to die naturally and does not want to be resuscitated. That document — the Colorado CPR directive — should be kept in an accessible spot, such as on the refrigerator or on the back of the front door, Rastrelli said. This helps a power of attorney or family member quickly locate it. Without it, emergency medical personnel will begin lifesaving efforts. Rastrelli said he encourages a living will. “It’s a gift to their family to have these discussions beforehand,” he said. A state-specific advance directive can be downloaded through Caring Connections, a program of the National Hospice and Palliative Care Organization at www.caring info.org. A national nonprofit, Aging With Dignity, offers the Five Wishes advance directive document. For more information about Five Wishes, or to download the document, go to www.agingwithdignity.org.