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January 19, 2015

Plan your care in advance

Daily Item of Lynn
by Stephanie Patel, MD, VP and Chief Medical Officer
Care Dimensions

This time of year lends itself to self-reflection, resolutions and is a good time to take stock of what is important in our lives and the lives of our loved ones.

At Care Dimensions, we believe that one of the most important resolutions you can make is to engage in advance care planning by completing an advance directive.

What is involved?

Advance care planning involves taking steps to ensure that you get the medical care you would want if you were unable to express your wishes for care.

One component is the advance directive, of which there are three categories: health care proxy, a durable power of attorney and a living will.

Each state has its own version of the legally accepted advance directive. Massachusettso only recognizes the health care proxy that names a health care agent to speak for you if you are unable.

It is a simple legal form that doesn’t require a lawyer or any legal representation. In fact, all you need to make it binding is two adults to witness your signature.

As important as it is to complete an advance directive, it is equally important to have a conversation with who you chose as your health care agent and other important individuals in your life so that they know what your wishes would be if you were unable to speak for yourself.

As a hospice and palliative care physician, I know that these decisions are not easy to contemplate. Most people think that they will have plenty of time, but as Ellen Goodman of The Conversation Project (theconversationproject.org) states, “it is always too soon before it’s too late.” Everyone 18 years of age and over should have an advance directive and consider voicing and documenting their health care wishes.

Figuring out ‘advance directives’

Advance directives are simple, easy-to-enact doc­u­ments. They are only for those situations where patients cannot speak for themselves. If you were under anesthesia for surgery, the advance directive would be used for any decisions that needed to be made. But once you’re conscious again, you would speak for yourself.

Be in control of your future

While there is no requirement that you must have one, a health care proxy gives you control over choosing who you would want making decisions on your behalf.

Research shows that people have strong feelings about how they’d like to be cared for at end of life, yet many people never have these conversations with their loved ones.

More importantly, a health care proxy isn’t limited to terminal illness — it is for any situation where you can’t speak for yourself, from an allergic reaction to a car accident.

Who can serve as a health care agent?

While many people assume their spouse or children would be the natural decision-makers, it doesn’t always work that way. When you can’t speak for yourself, the right to make decisions about your care is open to conflict.

One or more family members may disagree. The conflict regarding your wishes and who has the right to speak for you increases the stress surrounding the crisis, and may actually overshadow or delay your treatment while everyone involved tries to sort out who has the right to direct your care.

Choosing a health care agent and completing a health care proxy prior to a crisis can help alleviate stress and uncertainty for all involved.

Appointing a health care agent through a health care proxy is an important first step in making sure your wishes will be followed.

The next step is talking about and documenting what types of treatments you would or would not like to receive, such as whether you would want to use a breathing machine, have tube feedings or be resuscitated if your heart stops. Documenting your choices will make it easier for your health care agent to guarantee your wishes are carried out.

Care Dimensions would like to offer you a chance to document your health care wishes with a free copy of Five Wishes, one of several resources for assigning a health care proxy and documenting your wishes.

Our community educator, Pam Taylor, is also available to speak to local organizations, religious groups or clubs about this important topic. To request a copy of Five Wishes or to arrange a community education program, please call 978-774-7566 or email info@CareDimensions.org.

Stephanie Patel, MD, is vice president and chief medical officer of Care Dimensions in Danvers.


Since 1978, Care Dimensions has provided comprehensive and compassionate care for individuals and families dealing with life-threatening illnesses. As the non-profit leader in advanced illness care, we offer services in more than 90 communities in Eastern Massachusetts.