Care Dimensions: Who Will Speak for YOU if You Are Too Ill to Speak for Yourself?

Voices of Care

Who Will Speak for YOU if You Are Too Ill to Speak for Yourself?

Posted on April 16, 2019 by Mary Crowe, LICSW, ACHP-SW

Mary Crowe, LICSW, ACHP-SW, is the Director of Professional and Community Education at Care Dimensions and lectures frequently on the importance of advance directives.

Most Americans spend more time researching and thinking about their choices when buying a new car or picking out a day care center than they do thinking about their wishes for medical treatments if they are faced with a life-limiting illness or accident. Only a third of adults have any documents in place explaining what types of medical care they want, or more importantly, don’t want. We research and plan for everything in life, what makes us so afraid of confronting and putting some thought into the way we want it to end?

No one can possibly think of every situation that might happen to them in the future – just think of 52-year old Luke Perry who was fit and healthy and died in March from a massive stroke. But, you can stay in charge by putting your preferences in writing ahead of time so your doctor and family will know what kind of treatment you want, or do not want, in the event that you can no longer communicate.

Step 1 – Write it Down

Every adult over age 18 can express their wishes in documents that are called Advance Directives -- including Health Care Proxy, Power of Attorney, and Living Wills. Here’s an overview:

Health Care Agent/ Health Care Proxy: The first step in setting up an advance directive is to choose a health care agent. This is a person you trust who will make health care choices for you if you are not able to do so. This is an important role, so choose wisely. Make sure it is someone who understands your choices and who will honor them during a crisis.

A health care proxy, often referred to as a HCP, gives your agent the authority to make medical decisions for you. The HCP is a legally binding document in Massachusetts, but takes effect only when your physician determines that you are unable to communicate your wishes about your medical treatment.

Durable Power of Attorney: Another important document in planning is called a Durable Power of Attorney. It is highly recommended that this be drawn up by an attorney and determines who will manage your finances in the event of an incapacitating medical condition.

Living Wills/ Personal Directives: As medical conditions progress over time, it is important to set goals for maintaining quality of life. Addressing your personal thoughts and beliefs and preferences for life-sustaining treatments are often called living wills or personal directives. Every person defines quality of life differently and it is essential that family and medical professionals understand exactly what you want. Living wills are not legally binding in Massachusetts, but can be used by your health care agent as a guide to know what kind of medical treatment you want. This document can help start the important conversations needed in times of serious illness, including: What kind of life support treatment do I want? How do I want my pain managed? How do I want to be treated if I am near death? What are my burial wishes and preferences about organ donation?

Step 2 – Talk about It

Once your advance directives are completed and have been signed and properly witnessed, the job has just begun. It is important that you have continued discussions about your wishes with your family, physicians and others important to you. Give a copy of your advance directives to your physician and ask that it be kept in your medical records. Keep the original in a safe, accessible place with your important documents. This will help ensure that your wishes will be known at any critical time and carried out. If you change your mind about the choices you have made with your advance directive they can be revoked at any time by simply making a new advance care directive.

Sharing your health care choices is a gift you can give to those you love, giving them the confidence to act knowingly on your behalf. By having previously documented your personal wishes and choices, the decision-making burden for family, physician and friends is lightened. At the same time, your autonomy and dignity are preserved by tailoring medical care based on your own preferences.

Care Dimensions has a team of compassionate professionals who can assist you or your loved ones diagnosed with a life-limiting illness. We can walk with you every step of the way and provide assistance in making your decisions regarding your advance care needs. For more information on Care Dimensions and the expansive services we offer for persons with complex medical issues, call 888-283-1722.

There are several online resources that will help you start the conversation with loved ones and document your wishes - Honoring Choices MA, Five Wishes or The Conversation Project. You can also visit our website at ahead for links to these resources and more.

Take action now to make your health care wishes known and encourage your loved ones to do the same – they will thank you for it!

About the author:

Mary Crowe, LICSW, ACHP-SW, is the Director of Professional and Community Education at Care Dimensions, providing education to more than 7000 heathcare professionals and the community every year. She offers educational programs on more than 50 topics focused on caring for people at end of life, grief, caring for the caregiver, dementia, hospice and palliative care, aging, and advance directives. To request a speaker, call the Education
Request Line at 781-373-6616 or email

[ ]

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 95 communities in Eastern Massachusetts.