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Choosing your decision maker

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Recently I wrote a column suggesting that readers use the holiday season as a time to let family members know where they can find your important papers, should the need arise. Now I want to remind you that you also need to think about medical and end of life decisions that may be left to your adult children, spouse or trusted friend.

First you need to decide WHO will make health care decisions for you if you are unable to speak for yourself. A spouse or family member may be your first choice, but in a crisis, they may be too emotionally involved to carry out your wishes or to make any demands to hospital staff. The best choice is someone who knows you and your medical condition, has the ability to make decisions unemotionally and can tell your medical team what your wishes are. It is not a good idea to pick your brother who lives thousands of miles away because your ‘agent’ should be available to come to the hospital or wherever you might be.

To prepare for this, you can start by downloading a form called Advanced Health Care Directive and filling it out. These differ from state to state, so be sure you are using forms that are valid in your state. In California, UCSF has forms online, (www.ucsfhealth.org/pdf/advance_health_care_directive.pdf) as does Stanford University. Other states may call such forms “health care power of attorney.”

Once you have filled out the form and signed it, you can still change it at any time, even while you are hospitalized. You only need to tell your doctor. Remember, these decisions are designed for someone else to make only if you are unable to make them yourself.

Usually, your appointed decision maker or 'agent' will be the one to talk with your doctors, refuse or stop any medical interventions you had said you did not want, and even choose your doctors or hospitals. He or she will also be the one who determines, again after your specified wishes, if you want life support or not, if you want care that focuses on prolonging your life or if you only want care that will keep you comfortable.

This form is also a good place to indicate your feelings regarding donating organs. You may also include instructions saying whether you wish to die at home, in a hospice or in a hospital.

Ideally, you should be able to determine what your quality of life is at any given time but some people want their decision maker to work with the health care team and according to your wishes.

And don’t forget to leave a copy of the directive with your doctor, your hospital, and somewhere where you family can find it.

It may not be a pleasant task to put these decisions in writing, but now, while you are still healthy and mentally alert, is the best time to do it. Just think how relieved you will be when it is finished! Happy holidays!

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