Your Health

Making plans

Why you need to create a health care directive

Gwendolyne Nyhof and husband Craig Christie
Gwendolyne Nyhof and husband Craig Christie
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Frequently asked questions

Learn more about Health Care Directives

BY SUSIE STRACHAN
Winnipeg Health Region
Wave, March / April 2011

Gwendolyne Nyhof certainly knows how busy life can get. As a working mother with two small children, she spends much of her time juggling the demands of her job with the schedules of her kids, who enjoy hockey, cross-country skiing and summer league soccer, among other things.

She and her husband, Craig Christie, also keep busy by coaching the kids' teams, volunteering at the YM-YWCA, taking the family to the cottage and going cycling. But as a registered nurse, Nyhof also knows how quickly all the activity of life can come to a standstill. She understands how easy it is for someone to be in perfect health one day only to end up in the intensive care unit the next. She also knows how difficult it can be when family and loved ones are called upon to make important decisions around care for someone, especially when they have no idea what that person would want.

Having witnessed the confusion and heartache that can arise in such difficult situations, Nyhof knew she would have to take action to avoid a similar situation with her own family. She knew she would have to take control of things - before they took control of her.

"As a registered nurse, I've seen situations where families struggle to make the right decision for a family member who is incapacitated," she says. "I wanted to ensure my husband and I discussed our wishes, so if ever faced with such a difficult decision, we could be confident in making the right choice for each other, based on our values."

So, a few years ago, Nyhof started doing some advance care planning, a term used to describe the process of thinking about and documenting the kind of health care one would like to receive if they were unable to speak for themselves.

"My husband works in the financial industry, so this was a part of our larger plan that includes financial aspects, such as life insurance and a will," says Nyhof, in a rare moment of down-time amidst the whirlwind of driving kids to violin lessons or to the theatre.

A key part of the advance care planning process involves creating a Health Care Directive, a legal document often referred to as a living will, which guides the health-care team when you cannot speak for yourself. The Health Care Directive can assign a proxy - a relative or a friend - who will work with the health-care team in making health-care decisions for you. A Health Care Directive can also include details about what type of medical treatment you do or do not want.

The idea of creating a Health Care Directive is not entirely new in Canada, but it is becoming more common as people begin to recognize the important role it can play, according to health-care experts.

Lori Lamont, Vice President of Nursing and Chief Nursing Officer for the Winnipeg Health Region, says the importance of filling out a Health Care Directive cannot be underestimated. The document helps health-care providers and family members navigate tough medical situations.

"When you have a written Health Care Directive, it gives your family a better level of comfort when it comes to making what we know are difficult decisions about your health," she says. "And when your physician or health-care team is aware of those wishes, we can take that into consideration in planning your care."

Lamont says that very few Manitobans entering the health-care system have taken the time to write a Health Care Directive, which means the majority of people in life-and-death situations are leaving important health-care decisions in the hands of others.

The process of creating a Health Care Directive begins with reflection. Nyhof, for example, took the time to reflect on her basic values, her religious beliefs and what kind of care she would hope to receive at the end of life, and then discussed her thoughts on these issues with her husband.

"Having a Health Care Directive was just another task we needed to complete to ensure everything was in order in the event of a health emergency for the benefit of our family," says Nyhof. "My husband is my proxy. There isn't anyone who knows me better than him, and what I would want in a medical emergency. I trust him to represent my wishes."

Taking stock of memories of what happened when loved ones were ill is a way of prompting what might go into your Health Care Directive. Nyhof remembers what happened when her mother passed away a year ago, having spent the final eight years of her life in a nursing home. "It was important to identify to the nursing home staff what treatments would be implemented if she got worse, as she was unable to speak for herself," she says.

During the advance care planning process, you should talk to your family doctor or other health-care providers about what you are putting into your Health Care Directive, as medical procedures require explanation; something you won't get if you talk to a lawyer while you're writing your will.

A good conversation with your family doctor can be helpful because he or she will know what type of care can be provided to you when you are relatively healthy, along with what choices you will have should your condition worsen, says Dr. Luis Oppenheimer, the Provincial Director of Patient Access with the Winnipeg Health Region.

"You go to see your family doctor when you are sick. Now, you need to talk to your family doctor about starting to anticipate what might happen down the road. Talk about what happens as you age. Develop that trust with your family doctor, and discuss all sorts of things which might happen," says Oppenheimer, who has worked as a specialist in intensive care units for 30 years.

He also stresses the importance of filling out a Health Care Directive. "If you arrive in the ICU, we'll know what you would want done. We will work with your family on your care."

Dr. Mike Harlos, Medical Director of Adult and Pediatric Palliative Care with the Winnipeg Health Region, agrees. A massive stroke, a car crash, complications from appendicitis; all these could land you in the intensive care unit of a hospital tomorrow, says Harlos.

"Be proactive and determine your goals," he advises. "Explore the choices around tests, treatments and other healthcare options. Think about what you want to achieve. Your health-care team is there to provide information on medical and technical issues, to explain tests and treatments, and whether a goal is medically possible."

The wishes expressed in a Health Care Directive are binding on your friends, relatives and health-care professionals (unless they are not consistent with accepted health-care practices) and will be honoured by the courts.

However, health-care professionals are not obliged to search for or ask about a signed directive. It is important to be sure that your family, friends, your doctor and your proxy know you have a directive and know where it can be found.

Within the Winnipeg Health Region, anyone coming into a hospital will be asked whether they have a Health Care Directive, and will be encouraged to complete one.

Knowing that most people don't have a Health Care Directive, the Region is developing a campaign to raise awareness about the need to prepare for sudden health emergencies. It will include online resources like an advance care planning workbook that will help guide you through a series of questions and important issues to consider when making your Health Care Directive. It will also have answers to some common questions about end-of-life medical treatment.

Of course, no one wants to think about bad things happening, and it's certainly not easy talking about end-of-life medical care, but health experts throughout North America are emphasizing the need for people to get involved in their own care, early on.

"It's important to think about your future," says Harlos. "Having a Health Care Directive is a way to help your family and your healthcare team reach a consensus about your treatment. Writing down your wishes is your moment to let us know your philosophy about life, and how you would want to be treated, if you can't tell us yourself."

Susie Strachan is a communications advisor for the Winnipeg Health Region.

About Wave

Wave is published six times a year by the Winnipeg Health Region in cooperation with the Winnipeg Free Press. It is available at newsstands, hospitals and clinics throughout Winnipeg, as well as McNally Robinson Books.

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