By C. Nancy Wallace
For Coastal Senior

Nobody likes to think about being sick, incapacitated, unable to communicate, or dying. In fact most people are in relatively good health until just before they die.

However, a few do have things happen unexpectedly: We don't plan ahead to have a serious life threatening illness. There are a variety of things that can happen to the human body that result in our inability to communicate and tell our medical caretakers or our family and friends what we desire regarding our health care. For this reason it is important to have advance directives.

Advanced directives are documents that legally inform the medical community of your desires regarding your medical care in the event you are incapacitated and cannot communicate.

The durable power of attorney for health care legally enables another person whom you designate to make medical decisions for you in the event you are unable to express yourself. This person needs to be someone who knows what your wishes are and is willing to follow through on them. The medical and legal community sometimes refers to this person as the POA, the acronym for Power of Attorney. The word durable is necessary so they can act for you even though you are incapacitated.

A durable power of attorney for finances allows another person whom you appoint to take care of your financial matters. They can access your bank accounts to pay bills, make deposits, pay taxes, and handle other types of money matters such as stocks and real estate.

Now, suppose your medical emergency occurs at a point in time when the person you have designated as your attorney for health care is on vacation in Morocco. There is another document that needs to be completed by you as a part of your advanced directives called a Living Will.

This is a statement telling your doctor when to withhold life-sustaining treatment should you not be able to express yourself. Copies of this document should be in given to your physician, as well as placed on file at your hospital of choice. In addition, your POA should have a copy as it substantiates they are doing their best to see to it your wishes are being carried out. This could be critical if someone else in your family does not agree with what you would want and is present at the hospital telling the doctors what it is that they want done for you.

Now that you have some idea of why you should have these forms, you need to know where to get them.

You can get them from AARP, your attorney, your doctor's office or you can even get them off the Internet. All the hospitals have the forms and you can fill them out when you are admitted. In fact, they will ask you if you already have advance directives to ensure you receive the care you desire while at their hospital, even if you become unable to tell them directly.

This works well if you are able to communicate at the time of admission, but something could happen unexpectedly and then your next of kin (closest living and accessible blood relative) will have the ability to legally direct the hospital in your care. Theoretically this could be a person with whom you have never had a conversation about how you feel about life, what living means to you, and what you would want to have happen should you require life- sustaining procedures such as a ventilator to help you breathe or a feeding tube to provide your body with nutrition.

Many people are hesitant to discuss health-related concerns with other people. They may be superstitious and fear they will bring on their own demise if they talk about it. They may simply have been taught not to talk or think about unpleasant things. They may believe they should leave such matters up to God, that their fate is in his hands.

Regardless of the reason for not making decisions about your health care you need to know that the medical community must take all reasonable measures available to keep you alive unless there are legal documents, you have signed, in place to tell them otherwise. This means filling out advance directives and talking to someone about what you want done.

There are several things you can do to bring up the topic.

1. Be matter of fact. We all come in to this world, and we all go out. Just as births are different, so are deaths. Let the person you need to talk with know this is an important topic, as families can be burdened and/or torn apart when faced with life and death decisions without the knowledge of what the patient wants.

2. Make yourself some notes. Just like when making a speech, this helps you to remember all your important points. What would you want done if you were in a vegetative state (that is, just lying there not aware of yourself or your surroundings) with little hope of ever waking up or if you were terminally ill with little hope of ever getting better? Would you want to have feeding tubes to provide nutrition? Would you want to be kept alive under any circumstances? Would you want to be allowed to die?

3. Tell the person you want to make sure you are treated with what you consider dignity, not by someone else's standards. Tell them as specifically as you can the answers you came up with for yourself regarding what you would want done.

4. Ask them if they would be willing to serve as your durable proxy (POA). Would they feel comfortable about doing their best to see to it your wishes are carried out?

No one enjoys thinking about the end of their own (or a loved one's) life. This is a difficult discussion, but necessary. However, consider how much harder it is for a loved one to be faced with making decisions for you and not having any idea what you would want. If something unexpected has happened to you - your family already upset and sad - help them through a difficult time by completing advanced directives, making your wishes known to a durable attorney for health care proxy, and relieve them of the burden of having to make very hard decisions for you.

C. Nancy Wallace, LMSW, is a Master Social Worker and practices psychotherapy in Savannah. Her office number is (912) 447-0230.