Advance directives can go a long way toward making sure you get the type of care you want. There are potential stumbling blocks, however. Difficulties may arise when the values of healthcare providers differ from your own, or when the policies of health systems or care facilities conflict with your instructions. Here are some suggestions to help avoid such problems.
Choosing Healthcare Providers Who Will Respect Your Priorities
Establishing an understanding with your doctors and healthcare team is particularly important. In addition to general concerns (how will they work with you and your loved ones to honor your wishes; will they do their best to fully explain all procedures, treatments, alternatives, and risks; will they be available to answer questions and respond to your needs) you will likely want to explore some specifics. Some examples: choosing to stop unwanted treatment, start VSED, or request medical aid in dying; or choosing to extend life with ventilators, dialysis, or feeding tubes.
Compassion & Choices has a fact sheet, How to Talk to Your Doctor About Your End-of-Life Options, that you can review for ideas. Find it at CandC.org/tools. The toolkit that is within this guide contains a sample End-of-Life Wishes Letter to Medical Providers you can use as a starting point for your own letter or conversation.
Obtaining Referrals, If Needed
If your healthcare provider cannot support your end-of-life decisions or does not wish to manage your care, you always have the right to seek care from another source. You can and should be referred to someone else.
If your insurance company will only pay for services provided by a contracted healthcare system or group of physicians, you can contact your insurance company for a list of contracted providers.
Avoiding Problems if an Institution’s Policies Conflict With Your Wishes
It’s possible that in an emergency you could be admitted to a hospital whose policies conflict with wishes stated in your advance directive. Compassion & Choices offers a Sectarian Healthcare Directive as a possible addendum to your advance directive. It states that admittance does not imply consent to unwanted treatment and requests transfer if warranted.
Another situation worth guarding against is the possibility that an assisted-living facility’s policies would be in conflict with a resident’s wishes for a peaceful death. Adding a rider to the contract will clarify the resident’s expectations and the facility’s agreement. Our Advance Planning Toolkit includes such a rider for you to review.
In the Toolkit:
The sample End-of-Life Wishes Letter to Medical Providers (page 33) offers a starting point for your own letter to your doctor.
