April 15, 2014

Where there's a will, there's a way

Health-care professionals encourage advance directives


---- — SARANAC LAKE — One never knows when an illness or injury may suddenly leave a person unable to make their own medical decisions.

“If your family or your friends have no idea what your wishes are, they can’t advocate for you,” said Tania McCabe, professional liaison for Saranac Lake’s High Peaks Hospice & Palliative Care.

In honor of National Healthcare Decisions Day on Wednesday, area health-care professionals are encouraging people to establish advance directives, which include health-care proxies and living wills.

“The purpose of advance directives is to be able to plan for a time when some kind of treatment may be necessary and a patient is unable to express wishes at the particular moment,” said Marc Johnson, a social worker at Adirondack Health.


A health-care proxy, McCabe explained, is a document in which individuals designate someone as an agent to make medical decisions for them should they be unable due to conditions such as confusion or unconsciousness.

It also allows individuals to provide instructions or limitations regarding the use of certain medical treatments.

Similarly, living wills allow people to specify whether they wish to receive life-prolonging treatments in the event they have a mental or physical condition with no reasonable expectation of recovery. However, McCabe noted, these documents do not specify a health-care agent.

While New York state’s family surrogate law designates specific family members to act as the agent if no one has been named by the patient, according to Johnson, this can be a difficult undertaking for family members if they don’t know what the patient’s wishes are.

For that reason, he said, it’s recommended that people both discuss their wishes with their family beforehand and have a documented advance directive in place.

“I think the first step is often talking about the person’s view of quality of life versus prolonging life,” he said.


One basic thing to consider, Johnson noted, is whether one wishes to receive CPR.

When performed on young, otherwise healthy individuals, the emergency procedure can be life saving. But in older people with debilitating conditions, Johnson said, CPR is less effective and carries the risks of physical injury and loss of cognitive ability.

Individuals may also wish to limit the use of life-prolonging interventions, such as intubation, ventilation, artificial hydration and nutrition and antibiotics.

“People can talk to their primary-care physician or other health-care providers about these issues,” Johnson said.

Both he and McCabe urged people not to wait until they are older or critically ill to discuss and document their health-care wishes.

Sudden accidents and illnesses can leave even young, previously healthy individuals permanently or temporarily unable to express their treatment preferences.

“If you are over the age of 18, everyone should consider having a health-care proxy and a living will,” McCabe said.

Advance directives can be modified or changed whenever a person wishes, Johnson added.


High Peaks Hospice and Adirondack Health are hosting a free informational event about advance-care planning from 9 a.m. to 3 p.m. Wednesday in the main lobby of Adirondack Medical Center in Saranac Lake.

There, people will be on hand to answer questions, and advance-directive documents will be available to fill out.

The form that will be used at the event, McCabe said, is a combination of a health-care proxy and living will.

In addition, event staff will be available to provide pointers on how to discuss medical wishes with family members.

“It’s difficult for people to talk about life-threatening illness and the possibility of death,” McCabe said.

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