Understanding Advance Directives: Fill & Download for Free

I don’t ask a doctor their religious or political affiliation when I go to see them. The only things I ask are the following:1) Do you agree that a doctor/patient relationship is a partnership? The doctor knowing the medicine, and the patient knowing their body and how it reacts.2) Will you respect my religious beliefs and wishes, even if they conflict with your own?3) Will you be, at all times, open and honest with me? Never leaving out treatment options or glossing over the seriousness of a health issue due to your beliefs?If that’s all good, then we’re probably going to get along well. I don’t go to my doctor to get preached to. I also don’t go to my doctor to get half-truths, or to have them omit treatment options because it goes against their religious or political beliefs.Finally, I made a Living Will via Compassionate Choices - A Federal Attack on D.C.’s Medical Aid-in-Dying Law Threatens All Such Laws]Included in that Living Will are such things as a “Letter to my Doctor” that states the following:“It is important to me to have excellent and compassionate care - to stay as healthy and active as possible over the course of my life. At the end of life, my personal values and beliefs lead me to want treatment to alleviate suffering. Most importantly, I want to ensure that if death becomes inevitable and imminent, the experience can be peaceful for me and my family.If there are measures available that may extend my life, I would like to know their chance of success, and their impact on the quality of my life. If I choose not to take those measures, I ask for your continued support.If my medical condition becomes incurable, and death the only predictable outcome, I would prefer not to suffer, but rather to die in a humane and dignified manner. I would like your reassurance that: If I am able to speak for myself, my wishes will be honored. If not, the requests from my health care representative and advance directives will be honored.You will make a referral to hospice as soon as I am eligible, should I request it.You will support me with all options for a gentle death, including providing medications that I can self-administer to help my death be as peaceful as possible.I am not requesting that you do anything unethical while I am in your care, but I hope for your reassurance that you would support my personal end-of-life care choices as listed above.I hope you will accept this statement as a fully considered decision, and an expression of my deeply-held views. If you feel you would not be able to honor such requests, please let me know now, while I am able to make choices about my care based on that knowledge. “It also has a section regarding religious and other such institutions/hospitals:“ I understand that circumstances beyond my control may cause me to be admitted to a healthcare institution whose policy is to decline to follow Advance Directive instructions that conflict with certain religious or moral teaching.If I am an inpatient in such a religious-affiliated healthcare institution when this Advance Directive comes into effect, I direct that my consent to admission shall not constitute implied consent to procedures or courses of treatment mandated by ethical, religious or other policies of the institution, if those procedures or courses of treatment conflict with this Advance Directive.Furthermore, I direct that if the healthcare institution in which I am a patient declines to follow my wishes as set out in this Advance Directive, I am to be transferred in a timely manner to a hospital, nursing home, or other institution which will agree to honor the instructions set forth in this Advance Directive.I hereby incorporate this provision into my durable power of attorney for health care, living will, and any other previously executed advance directive for health care decisions.”As you can see, I take my healthcare options very seriously. They are mine to make, and I should be free to make them. I do not want my doctor to violate their own ethics (or the law), but if their ethical stance prevents them from following my wishes, then they need to transfer my care to someone who will be able to better follow my wishes, if possible and legal.A doctor-patient relationship is a partnership. I must do my part, as a patient, to listen to my doctor and follow their instructions to the best of my ability. By that same token, the doctor must listen to me and to how I report my symptoms and side-effects, and my limitations with regard to what I can and cannot do. I will not have a doctor that tells me that it is “My way or the highway”. If that is my choice, I will find a different doctor (unless there is a VERY good reason for that position - such as I will die without following their specific instructions).

Doctors don’t refuse life saving treatments. Plenty of doctors that I’ve known or treated have had chemotherapy, surgery and when necessary dialysis or feeding tubes.However, they’ve done those things when there has been meaningful chance of helping recovery. I’ve never had a doctor have a long term feeding tube or go on long term dialysis. But certainly for a complication from surgery or chemotherapy or to treat a very serious pneumonia, I’ve had doctors who’ve been on a ventilator, gotten dialyzed for a week or two, and had temporary feeding tubes to get through radiation or surgery for head and neck or esophageal cancer.What the large majority of doctors won’t do, is go through a treatment to unnecessarily prolong a death. They understand better than most patients what that means.But the public is coming around, and I’ve had a majority of patients who see me for cancer treatment who've completed an advanced directive that makes clear to the doctors and to their families what they are willing and not willing to go through in terms of medical care. Types of Advance Directives

Most doctors do not refuse chemotherapy. That kind of misleading claim is made based on a very small Canadian study when questioning about taking chemotherapy in the 80s for lung cancer.I have treated a fair number of physicians and they take chemotherapy based on standard recommendations and guidelines similar to other patients.What doctors tend to do differently is that we understand the futility of aggressive treatment near the end of life and make plans to avoid it. Taking chemotherapy to cure cancer or prolong quality of life is reasonable. Taking any kind of futile treatment whether it’s chemotherapy or something else is not reasonable.No feeding tubes, no resuscitation, no artificial assisted ventilation, no hail Mary chemotherapies with no chance of working. That’s what I advise my patients and that’s what I’ve stipulated for myself. Doctors tend to have advanced directives or trusts/wills that indicate what they don’t want done in a futile situation.Everyone else should do the same. It will reduce the stress on our loved ones if we make it crystal clear what our wishes are at that important moment in our lives.