28 Sep Ask Alice October 2020

We answer your questions about Advance Care Planning

Dear Alice,

When I signed my will several years ago, the packet of documents I received from my attorney included an advance directive that my attorney and I did not discuss in any depth. A friend says that really isn’t enough; but when I asked my attorney she said it was.

What do you think? Thanks, Confused

Dear Confused,

Excellent question. It’s understandably confusing because it sounds like your friend and your attorney have different views of the purpose or goal of advance care planning (ACP), and thus different views of what is enough.

If, like your attorney, you see the goal of ACP as having a legally valid document that specifies who you want to speak for you and your general choices of what types of treatment you would want if you couldn’t speak for yourself, then the documents you have already signed may be enough. It is certainly better than providing no guidance at all.

But if, like your friend, you see the goal of ACP as making meaningful and clear choices, so it will be easier for your agent to speak for you and more likely that your choices will be honored, then you may want to do more. From this perspective, ACP is a process, and while the legally valid advance directive (AD) is important, it is not the heart of the ACP process.

Specifically, the heart of the ACP process is a conversation (or series of conversations) with a trained facilitator, exploring subjects ranging from your past experiences with death to what you love most about life. You talk about what you desire most and what you fear most, and how that relates to deciding when the tipping point between life-extending care and comfort care has been reached. You talk about specific scenarios that might come up requiring decisions about specific treatments, and you talk about general beliefs and values, be they religious, cultural, or personal. You probe what the phrases “acceptable quality of life” and “life with dignity” mean to you.

The trained volunteer facilitators at Taking Steps Brattleboro can help walk you through this ACP process. They can also help you take what you learn from the conversation and express your wishes clearly in a new AD. But even if you choose to keep the old document you did with your attorney, they can walk you through the process of thinking about these questions and help you communicate your wishes to your agent, back-up agent, other loved ones, and doctors in less formal ways.

Lastly, please remember that ACP is an ongoing process. Your wishes and fears, as well as your views of what is an acceptable quality of life, may change over time; and your AD should reflect these changes. If you register your AD with the Vermont AD Registry (which we highly recommend, even if you stick with your old AD), the registry will periodically remind you to revisit your choices.

Thanks, and take care. Best wishes, Alice

As always, please contact Don Freeman, Taking Steps Brattleboro Coordinator, 802-257-0775, ext. 101, or don.freeman@brattleborohospice.org, for information about Advance Care Planning.

Till next month, folks. Please send your questions to Alice via
info@brattleborohospice.org.