The Importance of an Advance Health Care Directive

Intro: This is Weekly Dose of Wellness, brought to you by MemorialCare Health System. Here's Deborah Howell.

Deborah Howell (Host): Welcome to the show. I am Deborah Howell, and today we'll be talking about the importance of having an advanced healthcare directive. Our guest today is Pamela Reuben-Eubanks. Pamela is a board-certified adult gerontology nurse practitioner with over 24 years of professional nursing experience in acute and critical care areas. She is currently the Palliative Care Coordinator at Saddleback Memorial Medical Center and is also an active member of the Hospice and Palliative Nurses Association and Coalition for Compassionate Care. Welcome, Pamela.

Pamela Reuben-Eubanks, NP: Well, thank you very much. How are you?

Deborah Howell (Host): Wonderful. It's great to have you on the show today. Let's jump right in. What is an advanced health directive?

Pamela Reuben-Eubanks, NP: Well, I'm glad you asked, Deborah. I'm very passionate about this. An advanced directive is a legal document outlining a person's wishes regarding medical treatment. It usually includes a living will and a power of attorney that is able to carry out your medical decisions in the event that the person is not able to communicate to the doctor or the medical team.

Deborah Howell (Host): Got it. Everybody needs one, right? Why should we get an advanced directive?

Pamela Reuben-Eubanks, NP: Well, an advanced directive explains what you want to have as your medical treatment. It empowers you. It is your voice. It helps you to stay in control until the very end. You know, it's very important as we get older that we talk to our doctors about what we want for our medical care. And so that it gives us the opportunity to get as much as we want and our voices to be heard.

Deborah Howell (Host): Understood. What are the different types and who are the targets of each advance directive?

Pamela Reuben-Eubanks, NP: Okay. So there are different types, like you said. There are three types. There's a proxy or a double power of attorney. That's one. And there's a living will, which is an instruction directive specifying the medical treatments you accept or you want to reject. The proxy is for everyone, and so is the living will. If you are 18 or over, you qualify to fill out an advanced directive. The proxy allows someone who is able to make decisions on your behalf in case you're not able to communicate your wishes. And the living will gives instructions specifying the medical treatments that you want. There is a combination of the, there's a combination form with the durable power of attorney and the living will. There are different kinds. There's the five wishes. There is your state advanced directive. California has one specifically for the state. And there's also a post. The post is an actual order from the physician that specifies what treatments that the patient would like or the person doesn't want. And it is for people that are very ill, like seriously ill, and are in and out of hospitals, in nursing homes, in rehab, and maybe have three to four years till the end of life. And it tells the ambulance or the paramedics, if your heart were to stop, not to revive me. So it's for the outpatient person that is seriously ill. And so that if your heart were to stop, that you won't resuscitate the patient and bring them to the hospital after their heart stops. So it's a directive for people on the outside that are seriously ill.

Deborah Howell (Host): Got it. Got it. And there's nothing worse than waking up in a hospital bed with a thing around your wrist that says do not resuscitate. You don't want surprises like that.

Pamela Reuben-Eubanks, NP: Right. And with all of these advanced directives, you really need to talk to people about them. Say, for instance, your family, your physician, you need to let them know what your medical wishes are so that it is known. And you also need to have the advanced directive and the post in a visible area. It doesn't make sense to have this filled out all neatly and it's only known by you. It is done when it's accepted and known by others. So just make that more available for people to know what your wishes are. Don't keep it in a drawer or, you know, in your trust and, you know, base somewhere.

Deborah Howell (Host): Exactly. That brings me to my next question. It's kind of a two-part one. First of all, how do you go about filling out an advance directive and where do you get one?

Pamela Reuben-Eubanks, NP: That's a good question. One place is in your lawyer's office. I remember when I was doing just a regular trust, a financial trust, And that package was my medical advance directive. So the lawyer can help you to fill that out. They're also available in your doctor's office. They should be. And your doctors can help you fill that out. You can get one download, one from the Internet. And a lot of times these forms themselves come with really good directions that help you to fill that out. If you have any questions, I suggest that you speak to your primary physician first before filling these out, and especially someone who knows your medical condition and knows about the statistics or the benefits of the treatment, benefits and the harm of the treatment.

Deborah Howell (Host): Exactly. Now, who should be making medical decisions for you if you become incapable of making decisions on your own?

Pamela Reuben-Eubanks, NP: That's an interesting question because most people think, okay, my spouse, it goes, you know, automatically to your loved one or your spouse. But you want to make sure that the person you choose knows what you want, knows you very well, and you trust that they'll do what you want them to do. They'll carry out your direction. A real personal thing for me, about three years ago when I went to the lawyer's office and was filling one out with my husband, and, you know, automatically I thought my husband was going to be my POA or my DPOA, my top attorney. And so I asked him, well, what would you do? He said, well, I would just follow the doctor's orders, whatever the doctors say. And I was pretty petrified because, you know, I told him several times that I didn't want to be resuscitated. And, you know, for him to say that was just...

Deborah Howell (Host): Yeah, it was a little jarring.

Pamela Reuben-Eubanks, NP: Yeah. So you have to know that the person that you choose is going to carry out your orders.

Deborah Howell (Host): And be firm about it.

Pamela Reuben-Eubanks, NP: Yes, and be firm. Absolutely.

Deborah Howell (Host): Okay. Who should you give copies of your advance directive to?

Pamela Reuben-Eubanks, NP: Uh, the copies should go to people who know what to do. So definitely you're in your home, the spouse, the DPOA or the power of attorney that you've chosen, your physician should get one. And when you go to the hospital, they normally ask you for an advanced directive and scan it to their EMR, scan it to your records. So, yes, your power of attorney, say someone in the home, wherever you are, say you're in a still nursing facility, they should have one. In a rehab, they should have one. And the hospital definitely should have one. And any home that you're in, they should have one and know your wishes and know and have a very place, a visible place that it should be located.

Deborah Howell (Host): Do you have any suggestions of a visible place? Because I'm thinking about my home. I can't imagine where I would put it.

Pamela Reuben-Eubanks, NP: Well, you know what? The sicker you are, I think it's more important for you to have it as visible as possible.

Deborah Howell (Host): Got it.

Pamela Reuben-Eubanks, NP: So people that are fairly sick and have a post, they would stick it on the refrigerator or just on a desk that was just right there and visible and on the table. Those places, most people place them in their desk drawers. you know, just where you keep all your other valuable items.

Deborah Howell (Host): Yeah. That is really wonderful and just heartfelt information. The work you do is very, very important, Pamela. Thank you so much for your time today. We do appreciate it so much.

Pamela Reuben-Eubanks, NP: Thank you for having me.

Deborah Howell (Host): For more information or to listen to a podcast of this show, please go to MemorialCare.org. That's all for this time. I'm Deborah Howell. Thanks for listening and have yourself a great day.