Experts speak at Scoville Library, urge adults to document healthcare wishes

SALISBURY — Every adult should have an advance directive — a legal document that outlines future healthcare wishes — regardless of age or health, according to two end-of-life care professionals who spoke at the Scoville Memorial Library on Tuesday, July 28.

Cristin Rich, executive director of East Mountain House in Lakeville, a residential hospice that provides end-of-life care, joined Brenda Fife, a certified dementia practitioner and admissions coordinator at Geer Village in North Canaan, to discuss the benefits of the “Five Wishes” advance directive. Together, they encouraged attendees to begin conversations about their healthcare wishes before a crisis occurs.

An advance directive is a legal document that specifies what medical treatments a person wants if they become incapacitated and unable to make those decisions. It also typically designates someone to make healthcare decisions if needed on the person’s behalf.

Fife said advance directives are not just for the elderly or the sick.

“Every adult over the age of 18 should have one.”

Meanwhile, Rich added: “If you don’t make choices, the choices are made for you.”

The pair explained that there are five common types of advance directives: healthcare proxy, living will, POLST/MOLST (physician orders for life-sustaining treatment and medical orders for life-sustaining treatment), a dementia directive, and the Five Wishes.

The Five Wishes combines elements of those directives into a single document written in plain language that also addresses emotional, personal and spiritual preferences.

Rich and Fife walked the audience through each of the document’s five sections.
The first wish focuses on choosing a healthcare proxy — the person who will make medical decisions if the patient is unable to do so.

Fife said the ideal person is someone who will remain calm under pressure. “You should also name an alternate as well,” in case something happens to the first person.

The proxy “does not speak for you unless you are unable to speak for yourself.”

Fife said when picking the person to be the healthcare proxy, the question to keep in mind is “who is the best person to follow your wishes?”

The second wish addresses the kind of medical treatment a person wants or does not want if they are unable to communicate, such as whether they would want life-sustaining treatment or other medical interventions.

Fife added that this is not the same thing as a Do Not Resuscitate (DNR) order, which is issued by a physician. She said in general a healthy person cannot get a DNR order, and Rich added that a DNR “should not be in contravention of your wishes.”

The third wish focuses on comfort care.

Fife said this comes down to whether a person would prefer to have pain relief treatment that leaves them sleepy or if a person would rather be alert but experience more pain.

Rich noted that situations can change. “We had a patient who wanted to be awake and alert until the family members had been there. After that, pain medication was ok.”

She added that there are options other than opioid pain medications. “Distraction can be effective,” Rich said.

The fourth wish addresses how a person wants to be treated during their final days.

Fife said some patients prefer to have music playing, or enjoy flowers, or appreciate people coming to pray. It all depends on the individual.

“Me? If I’m not feeling well, I don't want people around me,” she said.

During the discussion, an audience member asked whether East Mountain House allowed pets.

Rich said pets are welcome as long as certain conditions are met. If the pet gets along with the resident therapy dog and can’t escape, then it’s usually okay.

“It’s not a hard yes or no.”

The fifth wish allows people to communicate what they want their loved ones to know.

“This is the most emotional wish,” Fife said. Some people write letters of gratitude or forgiveness.

Rich said that personal messages like those are what distinguish the Five Wishes document from more traditional legal forms.

“Sometimes these are words that family members will remember forever,” Rich said.

People interested in completing a Five Wishes document should first determine whether it is legally recognized in their state.

Rich said in 46 states the Five Wishes are legal, and in four more states (including Connecticut and New York), the Five Wishes require some additional legal provisions.

The pair also said it is important to keep the document up to date. One audience member said she prepared a Five Wishes document only to pull it out some years later and realize the proxy she had designated had died.

Fife encouraged people to revisit the document as life circumstances change.

“So don’t just put it in a drawer.”