The Critical Importance of Advance Healthcare Directives

Each of us has the privilege and responsibility to make our end-of-life decisions through an AHCD (Advance Healthcare Directive). This may be the single most important document we fill out in our lifetime, and it is an integral part of a routine Medicare wellness visit.

Let me tell you a story: During a routine wellness visit, I had a discussion with one of my elderly, frail patients about his end-of-life wishes. He expressed a desire to avoid any aggressive intervention such as feeding tubes or ventilatory support and preferred to be kept comfortable at home. But he failed to put his wishes in writing or file an AHCD electronically.

Six months later, I received a call from his family stating that he was extremely ill, intubated (on a ventilator) and being transferred to a nursing home. There was a difference of opinion between various family members about his ongoing care, so they requested my presence at a family conference. When I revealed his wishes, the family consented to withdrawal of life support and he passed away in the hospital.

In retrospect, if the patient had filed an AHCD, we could have avoided this heartbreaking situation, which involved initial aggressive intervention and ran completely contrary to his wishes. The family had to go through a lot of anguish and difficult conversation instead of using that time to process their loss.

If your doctor brings up an AHCD, it does not mean that something dire is happening to you. It is simply best to fill out Advance Healthcare Directives when a person is healthy and can think calmly about who they would designate to make medical decisions for them in the event they cannot speak for themselves. It is also important to recognize that just because you make plans to avoid aggressive interventions at the time of critical illness and plan ahead to die peacefully, you will still receive medical treatment for other illnesses. Any condition that is medically reversible and treatable will still be treated.

Currently the AHCD is available through your medical provider or online. It is crucial that you discuss your wishes with your loved ones. Once you have filled out the form, it needs to be signed in the presence of either a notary or 2 witnesses who are not related to you and are not your medical provider. The process of formulating an AHCD is a valuable opportunity to think about your preferences for the end of life and to communicate these desires to your loved ones.

Kuttancheri Rema, M.D.

Family Medicine Physician

Dr. Kuttancheri Rema has practiced family Medicine in the Bay Area for over 25 years. She derives great pleasure in caring for multigenerational families and getting to know her patients on a personal level. She strongly believes in shared decision making, compassionate care, and dignity of life for all, especially at the end of life stage.