It can be tricky to start a conversation with your parents or spouse about writing an Advance Directive for health care—but it’s important to plan ahead for end-of-life decisions.
Studies show that having advance directives reduces stress for family members who may have to make grueling end-of-life decisions.
But how can you get that conversation started?
Tune into SMG radio to hear Summit Medical Group’s patient relations manager, Mary Petti, RN, discuss the importance of planning ahead about end-of-life decisions, provide useful information about how to prepare an Advance Directive, and explain how to get sample forms.
Selected Podcast
Start The Discussion: The Importance Of Advance Directives
Featured Speaker:
Mary Petti, RN
Mary Petti is the Patient Relations Manager at Summit Medical Group and has lectured on the topic of advance directives. Mary spent many years in hospital nursing working with Oncology patients and then as Vice President of Patient Care Services. She was a member of the Bio-Medical Ethics Committee which dealt with end of life decisions in the hospital. Transcription:
Start The Discussion: The Importance Of Advance Directives
Melanie Cole (Host): It can be tricky to start that conversation with your parents or spouse about writing an advanced directive for healthcare but it’s so important to plan ahead for end of life decisions. My guest today is Mary Petti. She’s the Patient Relations Manager at Summit Medical Group. Welcome to the show, Mary. Tell us a little bit about what you tell people when they need to start that discussion about end of life care.
Mary Petti (Guest): It’s so interesting. So, many of us plan our wills carefully to provide for our loved ones and we don’t think about our own end of life decisions which are very important. We’re all going to die. Planning doesn’t make it happen any sooner but it can make things so much easier for the persons we love. It’s the last gift someone can give to their family.
Melanie: How beautifully put is that? So, how do you start that discussion because, Mary, some people don’t want to think about it? They don’t want to talk about it. Some others, it’s a business thing and it’s something important and you need to do it. But others don’t even want to start that conversation. How do you bring it up?
Mary: I try to think about some occasion when there’s no other drama going on. If it’s a spouse – a nice afternoon you may be sitting on a deck. You may be just reading on a Sunday afternoon. If it’s a parent, maybe you’re visiting with them. But I have found it successful to put it in the terms of “Honey” or “Mom, I would like you to do something for me. I know no one likes to think about death but it is something to plan for. I would like to know how you feel about some of the things that go on at end of life.” I think it’s a good idea to have one of the reference materials and give them to the person and ask them to review them and say, “You know, and then maybe we can get together for dinner and we can talk about some of the things you’ve read about.” Or, you may want to offer, “Let’s sit down and go over some of the things here.” I have a very good friend who is the head nurse in an intensive care and she tried to start the discussion with her mother. Her mother shut her down and said, “I’m not going to die anytime soon and this is gruesome. I don’t want to talk about it. Just know I want everything done.” Marie turned to her mother and said, “And that’s fine, Mom, and I will see to it that everything is done. But I want to tell you after 20 years in intensive care what everything is. I need to talk to you about that and then you can tell me what part of everything you want done.”
Melanie: Wow. That’s so common to say, “It’s gruesome and I don’t want to discuss it.” I’m sure that it’s common. So, let’s get into the technicalities, Mary. What is an advanced directive?
Mary: It’s a document that permits you to plan ahead so you can make your wishes known about your end of life care and you can select someone who will see to it that your wishes are followed. They become your proxy directive--your medical proxy. Your medical proxy – this person who will take on your medical decision making – is only used if you can’t make your own decisions. If you are unconscious; if you are not able to think; if you’ve had a stroke, say. If you do come back to cognitive functioning, that person’s responsibility goes away. So, if you’re able to make your decisions, you do. But if you can’t, your healthcare proxy that you have chosen will know what you want and will make those decisions for you.
Melanie: Who decides that you are unable to make those decisions? What is the parameter to say, “This person is unable to make their decisions”? Who does that?
Mary: Normally, your doctor. If it is a case of cognitive functioning, say, mental illness or something like that, there would be two physicians--one of them probably a psychiatrist who would have to certify that you are not competent to make your decisions. Most of the time, it is a non-issue because the patient is unconscious, on a respirator, not responsive, doesn’t participate in discussions and doesn’t respond to verbal stimuli.
Melanie: If somebody has filled out their advanced directive about end of life sustaining medical treatments, is this, first of all, a legal document?
Mary: It is and once someone makes out an advanced directive, we tell them to put it on file with Summit Medical Group or their healthcare provider’s office. If we have an advanced directive on file at Summit Medical Group, if you are admitted to a hospital and you the Summit Medical Group doctor or hospital is taking care of you, they can actually, from the hospital, look into your record to see your advanced directive. I know my sister has a particularly large hospital in California where she lives and she gave a copy to the hospital as well as to her doctor. It is a legal document but there have to be orders written in the hospital to match what you have in your advanced directive. But, if your healthcare proxy is following your directions and your advanced directive document is there, yes, the healthcare provider is bound to follow the patient and the healthcare proxy’s decisions. It makes it so much easier. Many times in the hospital, if there is an event and someone becomes unresponsive, if there were an advanced directive the staff would know what to do for the patient. We wouldn’t be resuscitating somebody who is in end stage cancer because we don’t have a do not resuscitate order and nobody has an advanced directive.
Melanie: Mary, what about emergency medical technicians? A lot of older people are living at home and maybe they are terminally ill and they’ve got an advanced directive. But, if somebody--their caregiver--calls 9-1-1, then is that advanced directive adhered to if 9-1-1 shows up at your house? Will they then not do any alternative measures to try and keep that person alive? What happens?
Mary: If EMTs come to your house, if they are summoned, they will do what they need to do to save your life. It will only be in the hospital setting where the advanced directive will be gotten. If you call, somebody they are going to work on you. They are going to intubate you. They are going to try to save your life and take care of the condition for which they were called.
Melanie: We only have a few minutes left, Mary. It’s such a great topic and you’re such a lovely lady. Please, in the last few minutes, just lay out, if you would what goes in the advanced directive. What should people be thinking about when planning these end of life decisions?
Mary: They should be thinking about somebody who is familiar enough with them and trustworthy who will follow their advanced directives. That may be a child, it may be a spouse, it may be a good friend. They have to choose someone for their medical proxy and they have to make certain decisions. I send them to NewJersey.gov and then look at “advanced directives.” This is a marvelous document on the state of New Jersey website. It goes into terminology. It explains advanced directive. It explains the healthcare proxy. It explains the terminology – tube feedings, end of life. Also, I have a booklet called Five Wishes which is in laymen’s terms and it is accepted in almost every state. You do not need a notary public, just a couple of witnesses. Our patients can call 908-977-9499 and ask for “advanced directive materials.” I will send them Five Wishes and I will send them a print out from NewJersey.gov on advanced directives. Then, they can call us back if they have any questions after they’ve reviewed the documents.
Melanie: And the number is 908-977-9499 and you can ask for Five Wishes about advanced directive. Thank you so much, Mary. It is really, really important information that you gave today. Thank you for being with us. You’re listening to SMG Radio and for more information you can go to SummitMedicalGroup.com. That’s SummitMedicalGroup.com. This is Melanie Cole. Thank you so much for listening.
Start The Discussion: The Importance Of Advance Directives
Melanie Cole (Host): It can be tricky to start that conversation with your parents or spouse about writing an advanced directive for healthcare but it’s so important to plan ahead for end of life decisions. My guest today is Mary Petti. She’s the Patient Relations Manager at Summit Medical Group. Welcome to the show, Mary. Tell us a little bit about what you tell people when they need to start that discussion about end of life care.
Mary Petti (Guest): It’s so interesting. So, many of us plan our wills carefully to provide for our loved ones and we don’t think about our own end of life decisions which are very important. We’re all going to die. Planning doesn’t make it happen any sooner but it can make things so much easier for the persons we love. It’s the last gift someone can give to their family.
Melanie: How beautifully put is that? So, how do you start that discussion because, Mary, some people don’t want to think about it? They don’t want to talk about it. Some others, it’s a business thing and it’s something important and you need to do it. But others don’t even want to start that conversation. How do you bring it up?
Mary: I try to think about some occasion when there’s no other drama going on. If it’s a spouse – a nice afternoon you may be sitting on a deck. You may be just reading on a Sunday afternoon. If it’s a parent, maybe you’re visiting with them. But I have found it successful to put it in the terms of “Honey” or “Mom, I would like you to do something for me. I know no one likes to think about death but it is something to plan for. I would like to know how you feel about some of the things that go on at end of life.” I think it’s a good idea to have one of the reference materials and give them to the person and ask them to review them and say, “You know, and then maybe we can get together for dinner and we can talk about some of the things you’ve read about.” Or, you may want to offer, “Let’s sit down and go over some of the things here.” I have a very good friend who is the head nurse in an intensive care and she tried to start the discussion with her mother. Her mother shut her down and said, “I’m not going to die anytime soon and this is gruesome. I don’t want to talk about it. Just know I want everything done.” Marie turned to her mother and said, “And that’s fine, Mom, and I will see to it that everything is done. But I want to tell you after 20 years in intensive care what everything is. I need to talk to you about that and then you can tell me what part of everything you want done.”
Melanie: Wow. That’s so common to say, “It’s gruesome and I don’t want to discuss it.” I’m sure that it’s common. So, let’s get into the technicalities, Mary. What is an advanced directive?
Mary: It’s a document that permits you to plan ahead so you can make your wishes known about your end of life care and you can select someone who will see to it that your wishes are followed. They become your proxy directive--your medical proxy. Your medical proxy – this person who will take on your medical decision making – is only used if you can’t make your own decisions. If you are unconscious; if you are not able to think; if you’ve had a stroke, say. If you do come back to cognitive functioning, that person’s responsibility goes away. So, if you’re able to make your decisions, you do. But if you can’t, your healthcare proxy that you have chosen will know what you want and will make those decisions for you.
Melanie: Who decides that you are unable to make those decisions? What is the parameter to say, “This person is unable to make their decisions”? Who does that?
Mary: Normally, your doctor. If it is a case of cognitive functioning, say, mental illness or something like that, there would be two physicians--one of them probably a psychiatrist who would have to certify that you are not competent to make your decisions. Most of the time, it is a non-issue because the patient is unconscious, on a respirator, not responsive, doesn’t participate in discussions and doesn’t respond to verbal stimuli.
Melanie: If somebody has filled out their advanced directive about end of life sustaining medical treatments, is this, first of all, a legal document?
Mary: It is and once someone makes out an advanced directive, we tell them to put it on file with Summit Medical Group or their healthcare provider’s office. If we have an advanced directive on file at Summit Medical Group, if you are admitted to a hospital and you the Summit Medical Group doctor or hospital is taking care of you, they can actually, from the hospital, look into your record to see your advanced directive. I know my sister has a particularly large hospital in California where she lives and she gave a copy to the hospital as well as to her doctor. It is a legal document but there have to be orders written in the hospital to match what you have in your advanced directive. But, if your healthcare proxy is following your directions and your advanced directive document is there, yes, the healthcare provider is bound to follow the patient and the healthcare proxy’s decisions. It makes it so much easier. Many times in the hospital, if there is an event and someone becomes unresponsive, if there were an advanced directive the staff would know what to do for the patient. We wouldn’t be resuscitating somebody who is in end stage cancer because we don’t have a do not resuscitate order and nobody has an advanced directive.
Melanie: Mary, what about emergency medical technicians? A lot of older people are living at home and maybe they are terminally ill and they’ve got an advanced directive. But, if somebody--their caregiver--calls 9-1-1, then is that advanced directive adhered to if 9-1-1 shows up at your house? Will they then not do any alternative measures to try and keep that person alive? What happens?
Mary: If EMTs come to your house, if they are summoned, they will do what they need to do to save your life. It will only be in the hospital setting where the advanced directive will be gotten. If you call, somebody they are going to work on you. They are going to intubate you. They are going to try to save your life and take care of the condition for which they were called.
Melanie: We only have a few minutes left, Mary. It’s such a great topic and you’re such a lovely lady. Please, in the last few minutes, just lay out, if you would what goes in the advanced directive. What should people be thinking about when planning these end of life decisions?
Mary: They should be thinking about somebody who is familiar enough with them and trustworthy who will follow their advanced directives. That may be a child, it may be a spouse, it may be a good friend. They have to choose someone for their medical proxy and they have to make certain decisions. I send them to NewJersey.gov and then look at “advanced directives.” This is a marvelous document on the state of New Jersey website. It goes into terminology. It explains advanced directive. It explains the healthcare proxy. It explains the terminology – tube feedings, end of life. Also, I have a booklet called Five Wishes which is in laymen’s terms and it is accepted in almost every state. You do not need a notary public, just a couple of witnesses. Our patients can call 908-977-9499 and ask for “advanced directive materials.” I will send them Five Wishes and I will send them a print out from NewJersey.gov on advanced directives. Then, they can call us back if they have any questions after they’ve reviewed the documents.
Melanie: And the number is 908-977-9499 and you can ask for Five Wishes about advanced directive. Thank you so much, Mary. It is really, really important information that you gave today. Thank you for being with us. You’re listening to SMG Radio and for more information you can go to SummitMedicalGroup.com. That’s SummitMedicalGroup.com. This is Melanie Cole. Thank you so much for listening.