Advance Care Planning



The Greatest Gift They Never Knew They Needed

Written by Katie Smoucha, RN

Certified Respecting Choices Facilitator and ACP Program Volunteer


As the holiday season approaches, many of us find ourselves wondering what to get our loved ones, or what gifts to ask for for ourselves. If you’re looking for something creative and unexpected, I have the perfect, if admittedly somewhat less-than-festive, solution: an Advance Directive.


As a geriatric nurse, I’m surrounded by people who are in their last years, weeks, and minutes of life, many of whom are no longer able to make their own medical decisions. These decisions will have big consequences for how their last years, weeks, and minutes play out, and yet they are often made by spouses, sons, and daughters who love the patient dearly and know them well, but have never actually had a meaningful conversation about what the patient wants the end of their life to look like. This arrangement can leave family members agonizing over the decisions they blindly made, result in patients receiving care they wouldn’t have wanted, and leave people forced to live out a quality of life that falls short of their expectations for their aging years.


An Advance Directive is a legal document that names the person that you would want to make health care decisions for you in the event that you could not make them for yourself, provides information to your decision maker about the quality of life than is meaningful to you, and describes the type of care you would or would not want. If you are thinking that you’re young and healthy and that doesn’t seem necessary, let me gently remind you that unforeseen accidents of all kinds happen to young people. If you’re thinking that you’ve got that one document somewhere you made with a lawyer twenty years ago, I can tell you that if you and your decision maker don’t know what’s on it or where to find it, and haven’t talked about your wishes, it won’t do you any good in a crisis. If you’re thinking that your loved ones know you well enough to know what you want even though you’ve never actually talked about it, I can tell you that the answers your loved ones give you may surprise you, and that faced with the stress of seeing your loved one in the ICU, you may forget everything they said if it isn’t written down. If you think that it’s enough for your family to know that you wouldn’t want “to be a vegetable” or wouldn’t want “extraordinary measures,” I can tell you that those ideas mean very different things to different people. If you’re thinking that that sounds like a depressing conversation topic, you’re right. I cried a lot filling out my document and discussing it with my family, but the few uncomfortable hours you face in completing and discussing your document could save your family years of worrying and wondering if they made the right decision.


The good news is that the communities PeaceHealth serves have an increasing amount of support to help you complete your Advance Directive. PeaceHealth has “Your Voice, Your Choice” classes that review the basics of advance care planning, provide a document, step-by-step information to complete the document, and a notary to finalize it, all for free.


An Advance Directive is a gift. It’s a gift for a husband watching his wife suffer with late stage Alzheimer’s and not knowing whether to treat her pneumonia, for the daughter wrestling with whether to try one more surgery to treat her mom’s heart disease, for the granddaughter deciding whether to put in a feeding tube, for all the family members I have seen suffer with not knowing what their loved ones would have wanted, and for all the patients I have had tell me that they no longer have the quality of life they want. For your family on the day that they are called upon to make difficult, life-and-death decisions for you, I promise you an Advance Directive will be the greatest gift they never knew they needed.


Sharing Your Wishes

Sharing your wishes for the care you want if you are critically ill can bring you closer to the people you love. Making your wishes known clearly in advance of a crisis is one of the biggest gifts you can give yourself, your family and friends.

Advance Directives are a gift of love and peace-of-mind. Consider the facts:

  • 90% of people say that talking with their loved ones about end-of life care is important, but only 27% have done so
  • 82% of people say it’s important to put their wishes in writing, but only 23% have
    done it

Conversations can make all the difference!