By Katherine Poarch and Debbie Schumacher

No one wants to think about what might happen in a life-or-death situation. However, it’s crucial to have a plan in place so your wishes are carried out. While these conversations can be difficult with loved ones, there are many reasons why they are necessary.

Having a plan, known as an advance directive, eases the stress when someone is going through a medical crisis. Families and caregivers can rely on it, knowing they are following the wishes of their loved one.

“The ability to stand in an emergency room... and really have a sense of what that person, that patient in the bed would want is a gift I really honestly can't describe,” said Danielle Noreika, M.D., the medical director of palliative care at VCU Medical Center.

Noreika joined Healthy with VCU Health, a podcast created with VCU Health experts, to share important information for you and your family to consider when it comes to advanced care planning.            

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What is an advance directive?

An advance directive is simply a document that lists your goals and wishes for future care. Often, this testament arises from conversations with family members or caregivers.

The document itself can be completed by a number of individuals, including lawyers, healthcare providers, social workers and chaplains. In Virginia, residents are allowed to create an oral agreement, but it’s always best to have an advance directive in written form so the wishes of that person are clear.

We really encourage people not only to consider the form itself, but also consider having conversations with their loved ones about what's important to them for their medical care.

Who should make an advance directive?

Advance care planning is really designed for people who are 18 years of age or older. At this point, you’re considered an “adult” and have the capacity to understand what you would like your future care to look like.

Advance directives are also intended for adults who have the legal capacity to understand what’s going on with their own health.

When you are younger and healthier, it may seem like it's not a tool that applies to you, but we do encourage everyone to consider thinking through that process and giving family members an idea of what's important to them. We never know what the future holds, and we always want to be prepared.

When does the advance directive get activated?

An advance directive only becomes “active” when a person is unable to make decisions with their medical care team. For example, if someone is in intensive care and on a breathing machine or had a head injury and was confused, providers and their appointed medical decision maker would use this document to determine the next steps for treatment.

It’s helpful to include an advance directive in your medical records, so it’s easily accessible. It's also beneficial to have multiple copies – at home, in your vehicle’s glovebox, and with the person who has been identified as the medical decision maker.
You should also make sure to revisit the directive each year or anytime your goals and wishes have changed.

How can I get started?

Filling out an advance directive form isn’t complicated; it’s actually a very straightforward process. The most difficult part is building up the courage to have the conversation.

What we really want people to do is reflect on what's important to them and what needs to be present as far as quality of life. If someone wants to go through with very difficult medical therapies, it’s helpful to have an honest conversation with their decision makers about what that looks like.