Dan Morhaim, M.D.

April 16: National Healthcare Decisions Day - Helping Yourself, Helping Others

"In this world nothing can be said to be certain, except death and taxes." – Benjamin Franklin

No doubt about it. Death is inevitable, but we are the first generation in human history that has some say about how, when, and where we die. This is done by completing free legal documents known as Advance Directives (AD), available in every state for decades. Unfortunately, only about 40% Americans overall – and about 20% in communities of color - take advantage of this tool for empowerment, control, and respect for individual values. Our culture celebrates personal autonomy and freedom; yet in this one area, we collectively abdicate that opportunity.

As an Emergency Medicine physician for over 40 years, I'm accustomed to making difficult decisions, sometimes under time pressure, especially when it comes to managing advanced illness in life-and-death situations. I want to know what my patient wants and how far I should go to save them. Too often when such a patient arrives, precious time is lost trying to find that out. I've seen frustrating and easily preventable episodes of less than optimal care given because that key information was missing. I've seen families thrown into conflict and crisis when suddenly faced with these decisions. Clinicians want to respect their patients' wishes, and we strive to do our best to communicate with patients and their families.

Consider what kind of care you'd like if you couldn't speak for yourself, and who would you want to represent you if that were to happen? These are tough questions, but ones that each of us should consider before being confronted with a medical crisis. All of this was made more compelling during the pandemic because patients were often not able to communicate, and families were not allowed at the bedside.

If you don't take proper action, decisions about your care could be made by a government agency, an insurance company, a hospital ethics committee, relatives you might not want in that role, clinicians who don't know you, or others who will be without your guidance and possibly driven by values that may not be your own.

April 15 is tax day, and you've likely planned for that. April 16 is "National Healthcare Decisions Day". It's there to remind us to take these steps for ourselves and our loved ones, linking death and taxes in a way that's useful.
The benefits of Advance Directives are many. Care is personalized. Values are respected. Intra-family conflicts are minimized or avoided. Clinicians know what kind of care patients want. The racial disparity will decrease. The end-of-life experience becomes more holistic, manageable, and compassionate. Health care costs are reduced (some estimate 20% of Medicare alone) the right way, by respecting our wishes and values.

Have you completed your AD? If so, please update. If not, these forms are available from a variety of sources including your state or local department of health; AARP; faith-based organizations, your doctor or hospital, and various online ones (my personal favorite is mydirectives.com), all at no cost. The forms are legal in every state, and attorneys are not required. These take a few minutes to fill out, but it's time well spent. You can update your AD anytime as your life circumstances change, and it's the most recent one that applies.

It's not just for old people. The three most famous cases in American medical-legal history on this subject were women under 30 (Karen Quinlan, Nancy Cruzan, Terry Schiavo). When my children turned 18, I gave them their own AD forms to complete, and one pointed out that she'd already considered this when she made organ donation decisions upon getting her driver's license.

We can have both the best of modern medicine and the choice of when enough is enough. If it turns out that I'm in a terrible car accident or have a heart attack, then please call the ambulance and take me to the hospital. But if I have advanced terminal cancer, long past any hope of recovery after all treatments have been tried and failed, I don't want to die in a hospital tied to tubes and machines, suffering every minute to the end, cut off from the people who care about me. When the end comes for me, I want to be at home, pain free, with my friends and family close by.

Talking about end-of-life care is a topic we collectively avoid. That's understandable. But that doesn't mean we shouldn't take advantage of the tools we are afforded today. After all, you are the one person who can complete your Advance Directive; no one can do it for you. So...do it now.
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Dan Morhaim, M.D. is a prior ER physician, state legislator, and author of Preparing for a Better End: Expert Lessons on Death and Dying for You and Your Loved Ones. 
Contact - danmorhaim@gmail.com