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What Happens If You Can't Speak for Yourself? Make End-of-Life Planning a Priority With an Advanced Care Directive

Most people don’t want to think about how their life will end, but the topic should be one that every adult considers. If you become unable to speak for yourself due to terminal illness or traumatic events, who will decide what happens to you? Do you want to be kept alive with machines and medications or do you wish to pass away without extreme measures being taken?

Will your family have to make those decisions for you, and if so, will they fight and cry with each other about what should be done?

Having an advance care directive in place helps your family members honor your wishes about the care you want to receive if you become incapacitated. But less than 20 percent of people entering hospitals have one.

National Healthcare Decisions Day is April 16 and is designed to inspire, educate and empower the public and providers about the importance of advance care planning. Even if you are healthy, young or unwilling to even think about end of life, now is the time to put an advance care plan into place.

“An advanced care directive is a form that allows us to decide what it is that we want for ourselves in the latter stages of our life,” says Dr. J.D. Lackey, director of utilization medicine at INTEGRIS. “Without that, who's going to make those decisions for you? If you're the kind of person – and all of us are – who would rather make those decisions for ourselves, then you need an advanced care directive. Consider it a gift to your family so they don’t have to agonize over those decisions for you.”

When should you put your advanced care directive in place? According to Dr. Lackey, the time is now.

How an advanced care directive works

An advanced directive is a legal document that goes into effect only if you are incapacitated and unable to make your own decisions. The directive helps your family members, loved ones and health care providers know what kind of intervention or medical treatments you choose or refuse to have if you are terminal, in an end-stage condition or persistently unconscious.

“You can go online and just search for ‘end of life care,’ ‘living will,’ ‘advanced care directive,’ or anything similar to that,” Dr. Lackey says. “We at INTEGRIS have tried to make the form as user-friendly as the law allows.”

On the advanced directive form, also called “a living will,” are questions about your wishes on receiving the following treatments.

  • CPR if your heart stops beating or your breathing stops
  • Feedings through a tube into a vein or into the stomach
  • Extended care on a breathing machine
  • The use of dialysis
  • Medicines, surgeries or tests
  • Blood transfusions
  • Organ and tissue donation

“This becomes important because there is very often a disconnect between what the patient wants and what the family says they want,” Dr. Lackey says. “Your loved ones may have a lot of very conflicting emotions and may fight over what to do. It's a horrible position for family members to make those kinds of decisions if we don't specifically and clearly know what the person wants.”

Please visit online at to access the form.

How to make sure your wishes are honored

Once you have the simple advance directive form filled out, be sure to give copies to family members, health care providers and anyone involved in your health care. Copies should also be carried in your wallet or car and put on the refrigerator at home as emergency personnel know to look there for important papers. If you are hospitalized, take a copy with you to give to the medical staff.

It's important to note the living will part of the advance directive is not the same as a last will and testament. In addition, the advanced health care directive does not name the person who can make health care decisions for you.

“The form walks through some fairly simple questions like, ‘In this situation, what would you want?’ Do you want all of it? None of it. Somewhere in between?” Dr. Lackey says. “We in the medical community are really good at finding out what's the matter with you. We're not as good at finding out what matters to you. So, let's do that in a way that everybody understands so you can have confidence that if you get to the point where you're not able to communicate, your wishes will be honored.”

Other types of advance directives

An advanced care directive is different from a durable power of attorney or special health care power of attorney.

A durable and special health care power of attorney are legal documents that name who your health care proxy will be to make health decisions for you if you are unable to do so. A power of attorney can be prepared without a lawyer, but the documents must be notarized and signed in the presence of at least two witnesses who are not related and are not named in a will.

Another type of directive is a do not resuscitate (DNR) order that tells medical providers not to attempt CPR if your breathing stops or your heart stops breathing.

You can also make decisions about organ donation in an advance directive.

All these forms and decisions can be changed at any time, and Dr. Lackey suggests reviewing the documents at least once a year to make sure your wishes remain the same.

“Everybody should make that decision for themselves,” Dr. Lackey says. This is something everybody should think about it. Decide what matters to you and decide how you want your end of life to be.”

“An advanced care directive makes it easier on your family and your caregivers. Without one, we're just guessing about your end-of-life wishes,” he says. “Everybody is better off if doctors are doing things because we know we're honoring and respecting what you want.”

You can receive the legal Oklahoma Advanced Directive forms from your doctor, attorney, your hospital, or you can download them here or visit INTEGRIS at