1. Exploring the Issues

Start by imagining situations where:

• You suddenly become incapable of making your own decisions.
• It is clear you will have little or no recovery.
• Your injury or loss of functions is significant.

These types of situations may arise because of an injury to the brain from an accident, a stroke, or a slowly progressive disease like Alzheimer's.

Many family members have told us that vague statements like "I don't want to be a vegetable" or "I don't want to be hooked up to machines the rest of my life" just aren't helpful enough to guide them when they have to make decisions during these very stressful situations.

Consider your personal values about quality of life. What makes being alive meaningful to you?

Talk about the circumstances under which your goals for medical care would change from prolonging your life to being allowed to die a natural death. In some situations certain treatments may not make sense because they will not help, but other treatments will be of important benefit. Some people want everything possible done to delay death. Others don't want dying to be prolonged. Where would you draw the line?

Consider these questions:

• What do you value most in life?
• What concerns you most about death and dying?
• What type of spiritual support would comfort you near the end?
• How does cost influence your decisions about medical care?
• What role does your religion play in how you live your life? Are you familiar with your religion's position on end-of-life concerns?

2. Discussing Your Decisions

It is important to have these conversations now:

Discuss your decisions with the people you trust now. Don't wait until you are admitted to a hospital with a life-threatening situation. In that event, you may not be able to make your own decisions, and the choices will fall on the shoulders of your distressed family members in the waiting room. This may leave your loved ones guessing and unsure of your own wishes.

It is always difficult for people to accept that a loved one is dying; especially since doctors usually can't predict how much time a patient has to live. The subject of dying is often avoided for fear that it means "giving up." But, when family members are helped to face what lies ahead, they are better able to seek the care best suited for their loved one.

Many questions need to be addressed to help understand the patient's medical condition and what comes next:

• Is it still possible to cure her/his disease or illness?
• If no cure is possible, what are the chances he/she can at least improve?
• Given his/her current condition, what do you expect in the next few months? In the next few weeks?
• Are other medical problems likely to arise?
• What are the treatment options?

3. Appoint someone to make Health Care Decisions for you.

Name the person who will be your Health Care Proxy or Patient Advocate.

If both your attending physician and another health care professional find that you can no longer make health care choices, this person will speak for you. Many people choose a close family member, but you are free to pick anyone you think could best represent you.

The person you appoint should have all of the following qualifications:

• 18 years of age or older.
• Knows you very well and care about you.
• Trustworthy, and likely to be nearby in the event of an emergency.
• Willing to accept this responsibility.
• Willing to follow the values and instructions you have discussed.
• Willing to stand up for you and insist your wishes are honored.
• Able to make complex, difficult decisions during stressful situations.

4. Completing the Forms

Choose an Advance Medical Directive that helps you describe not only your medical wishes, but also your personal, emotional and spiritual wishes.

You have a legal and moral right to decide what kind of medical treatment you want and don't want when you are seriously ill and your death is imminent. In Michigan, you do this by choosing a proxy, a person to make health care decisions for you when you are no longer able to speak or think clearly for yourself. This person is sometimes called your Patient Advocate.

Be specific when describing your wishes. Some examples are:

• I do not want to be in pain. I want my health care providers to give me enough medication to relieve my pain, even if it means that I will sleep more than usual.
• I want to die in my own home.
• I want to have my favorite music played often, even if I am seemingly unresponsive.
• I want friends and relatives to visit, hold my hand, and talk to me about the daily lives of their families.
• I wish to have others by my side praying for me when possible.

If you would like more information regarding Advance Directives or help in completing the forms you may call 989-362-9368