White River Junction — Advance directives come up frequently in conversations about health care decision-making as people age.
Their purpose is to provide written instructions for medical care in instances where a patient is unable communicate them herself.
Jill Morton, a community care social worker at the White River Junction VA Medical Center, runs advance directives workshops twice a week for veterans and their families.
In an email Q&A, Morton discussed what advance directives are and why they are important. The interview has been edited for length, style and clarity.
Question: In simplest terms, what is an advance directive?
Answer: The short answer is that an advance directive is a legal document that states a person’s preferences for medical treatment and medical decision-making. Most advance directives have two components: The durable power of attorney for health care — which appoints someone to make medical decisions should the person lack capacity to decide for themselves — and a “treatment preferences” section (sometimes referred to as a living will), where a person can specify what kind of treatment they would or would not want in different circumstances.
Treatment and care preferences usually focus on what is desired at the very end of life and in situations of being in a permanently unconscious state, although other preferences can also be expressed, including pain control, acceptance of blood products, spiritual care preferences, mental health care, and who should and should not be involved in discussions about your treatment.
Q: Why are they important?
A: For most people, a key desire is to avoid aggressive care that can cause suffering and prevent meaningful interactions with loved ones at the very end of life.
Other people wish to avoid huge financial burdens related to care that has no benefit. Others want to spend their last months, weeks, or days at home with loved ones with comfort-oriented care, with the best chance of being alert and able to participate in normal day-to-day activities.
Advance directives can provide reassurance and comfort to loved ones in that they know what you would want for care and are not saddled with the responsibility of choosing for you.
Q: What does a person need to do to put together an advance directive and what are the first steps they should take?
A: In short: “Think about it, talk about it, complete an AD.” Think about your treatment preferences — starting with situations of being at the end of life or permanently unconscious — and consider who would be the best person to make decisions for you in line with your stated wishes and values. This person should be someone you trust, who knows you well, who can handle making complex decisions in a stressful medical environment and communicate effectively with doctors and other loved ones.
Then, review and complete an advance directive form. In Vermont, a widely recognized AD form is provided by the Vermont Ethics Network. The short form is most often used, but there is also a longer form for people who really want to spell things out in detail
. In New Hampshire, the Foundation for Healthy Communities has created a straightforward AD document that complies with N.H. law. The VA provides an advance directive for veterans.
However, you can choose any document that complies with local and state laws. Documents for the VA, New Hampshire and Vermont require two witnesses for your signature. The Twin States have an optional page for a notary signature. Once completed, copies of an advance directive should be provided to your agent, alternate agent, local hospital and primary care provider. Keep the original and copies in a place where they can be retrieved easily.
Q: Who should be involved in the process?
A: You and your loved ones and/or chosen surrogate decision-maker(s). Your agent does not need to be present when you complete your advance directive.
Q: Are advance directives different for veterans? Why?
A: Veterans in New Hampshire and Vermont have the same options for completing an AD as non-veterans. They can choose to complete the form provided by the VA or a state advance directive. State AD forms and VA forms are honored across health systems, so only one is needed.
Q: At what age should someone get started on planning their advance care?
A: Any adult of any age and health status can benefit from having a basic advance directive. Medical crises can happen to anyone.
Q: How can someone learn more about advance directives?
A: Veterans and their loved ones can learn more about advance directives by attending one of the weekly “Advance Care Planning” workshops held on Wednesdays and Thursdays, 1-2 p.m. in Building 39, Room 241, at the VA in White River Junction. Dartmouth-Hitchcock Medical Center also offers free one on one consultations and advance care planning workshops at various locations in Vermont and New Hampshire through their Honoring Care Decisions program. They can be reached at 800-730-7577.
Editor’s note: Morton can be reached at 802-295-9363, ext. 6923 or Jill.Morton@va.gov. Liz Sauchelli can be reached at esauchelli@vnews.com or 603-727-3221.