Thursday, April 9, 2009

How to Ensure Doctors Follow Your Health Care Wishes

April 16 is National Healthcare Decision Day; A good Time to Write your Advance Directive

MAYWOOD, Ill. -- Years before they died, Russell George and his wife, Dorothy, sat down with Dr. Laura Saelinger-Shafer of Loyola University Health System to prepare their living wills.

A living will states that in the event a person becomes terminally ill and is unable to communicate, he or she does not want any procedures that would only prolong the dying process. On April 16, Americans are being urged to complete living wills and other types of advance directives, in observance of National Healthcare Decisions Day.

After Russell George was diagnosed with advanced pancreatic cancer, he died at his La Grange Park home at age 84. "He slipped away peacefully," said his daughter, Meredith Onion.

The following year, Dorothy George became terminally ill from complications from heart disease, diabetes and Alzheimer's disease. Like her husband, she was in Loyola's hospice program and died at home, without being hooked up to tubes and machines. "It was as peaceful and dignified as it could be," Onion said.

Onion said that because her parents had prepared advance directives, "I was never put in a position of having to guess what they would have wanted."

Saelinger-Shafer said it can be difficult for people to talk about such issues, especially when they are still healthy. "But health care decisions are easier to make ahead of time, when it's not a crisis situation."

Saelinger-Shafer added that patients should make sure to bring their advance directives to their doctors. "If the forms sit in a drawer, and no one knows about them, then we can't know a patient's wishes," she said. Saelinger-Shafer is an internist with a special interest in geriatrics, and a clinical assistant professor in the Department of Medicine, Loyola University Chicago Stritch School of Medicine.

Loyola is taking the lead in educating doctors and patients about advance directives. Each patient admitted to Loyola University Hospital is asked whether he or she has an advance directive, and if so, to bring it in. If not, the patient is given information on how to fill one out. Advance directives are scanned into the hospital's electronic medical record system, and prominently displayed on the home screen of each patient's electronic file.

"Determining what kind of care you would want is a fundamental patient right," said Sharon Englert, director of patient relations. "Loyola places a great priority on preserving and supporting our patients' right to determine and participate in their own care."

A living will is among several types of advance directives. Other documents include:

Health Care Power of Attorney. This designates whom you would like to make health-care decisions for you if you are unable to do so yourself. It also states whether, for example, you would like to be an organ donor or have life-sustaining treatments.

Living Will. This takes effect if you become terminally ill. It states that you would not want any procedures done if they would only prolong the dying process.

Do-Not-Resusciate Order. This states you do not want cardiopulmonary resuscitation if your heart stops and you stop breathing. Measures to promote patient comfort and dignity will be provided.

Mental Health Treatment Preference Declaration. This states whether you would want to receive electroconvulsive treatment or psychotropic medicine if you have a mental illness.

"Ideally, every adult should have an advance directive," said Dr. Theresa Kristopaitis, medical director of Loyola's Center for Home Care & Hospice. "Even if you are young and healthy today, it is important that you take the time to think about and discuss your wishes with our physician and loved ones."

About Loyola University Health System

Loyola University Health System (LUHS) is part of Trinity Health. Based in the western suburbs of Chicago, LUHS is a quaternary care system with a 61-acre main medical center campus, the 36-acre Gottlieb Memorial Hospital campus and more than 30 primary and specialty care facilities in Cook, Will and DuPage counties. Loyola University Medical Center’s campus is conveniently located in Maywood, 13 miles west of Chicago’s Loop and 8 miles east of Oak Brook, Ill. At the heart of the medical center campus is a 559-licensed-bed hospital that houses a Level 1 Trauma Center, a Burn Center and the Ronald McDonald® Children's Hospital of Loyola University Medical Center. Also on campus are the Cardinal Bernardin Cancer Center, Loyola Outpatient Center, Center for Heart & Vascular Medicine and Loyola Oral Health Center as well as Loyola University Chicago Stritch School of Medicine, Loyola University Chicago Marcella Niehoff School of Nursing and the Loyola Center for Fitness. Loyola's Gottlieb campus in Melrose Park includes the 255-licensed-bed community hospital, the Professional Office Building housing 150 private practice clinics, the Adult Day Care, the Gottlieb Center for Fitness, Loyola Center for Metabolic Surgery and Bariatric Care and the Loyola Cancer Care & Research at the Marjorie G. Weinberg Cancer Center at Melrose Park.

Trinity Health is a national Catholic health system with an enduring legacy and a steadfast mission to be a transforming and healing presence within the communities we serve. Trinity is committed to being a people-centered health care system that enables better health, better care and lower costs. Trinity Health has 88 hospitals and hundreds of continuing care facilities, home care agencies and outpatient centers in 21 states and 119,000 employees.