At Schluter & Hughes, we believe estate planning and advance care planning go hand-in-hand.  A recent American Bar Association workbook focused on the combined medical and legal perspective when it comes end-of-life planning and advance directives. An advance directive is a legal document that allows you to express your decisions about end-of-life care ahead of time. This type of document allows you to communicate your wishes to family, friends, and healthcare professionals prior to a decline in your health.

As a physician assistant who has spent a large portion of my career caring for patients in the hospital, I have seen all too often the confusion and chaos that can result for patients and families when these discussions have never taken place. Families end up making critical decisions for their sick loved ones with no idea what their wishes might be, and these decisions are often made under extreme duress.

This is a difficult topic that is uncomfortable for most families to discuss but is so important. Most of us perform preventive maintenance on our vehicles, use a financial planner to assist us for long-term management of our wealth, and have met with an estate planning attorney to allocate where our assets should be distributed after our death, but we don't do the same type of planning for our healthcare goals.

An over-simplified question that is often asked is whether we would want our family to “pull the plug” if our heart were to abruptly stop beating and if we were to stop breathing. However, this situation is actually quite rare, and questions about our healthcare wishes and goals of care need to be more nuanced.

More helpful questions would be, would I want to be kept on life support (a breathing machine, intravenous fluids, and artificial nutrition through a feeding tube) if I sustained a severe injury and was unable to regain consciousness? Would I be willing to be placed on life support temporarily if it gave me the opportunity to recover from a significant illness or injury that is potentially reversible? If I have a terminal illness, would I want to use all measures to prolong my life as long possible, or would I want to be made comfortable and remain in my home?

The American Bar Association learning course that focuses on planning from both legal and medical perspectives, emphasized the importance of collaboration between attorneys and healthcare professionals. By combining the legal and the medical together, families have a comprehensive plan to refer to and rely on in the event of a major health change. Having a game plan already in place means that when the unexpected occurs and emotions are running high, all parties can refer to the documents that were created intentionally and thoughtfully and feel confident that the wishes of their loved one are well-documented and will guide their medical decision making. Plans can even include discussions about organ donation, funeral planning, and who will care for pets that may be left behind.

When families discuss healthcare goals and end-of-life wishes in advance, it leads to meaningful conversations about what defines an individual's quality of life. And in the hospital setting, it removes the burden of anxiety and guilt of making a “wrong” decision on a loved one's behalf.

Over my career, I have been at the bedside for hundreds of patients who were facing a medical crisis. Families who had already discussed goals of care and end-of-life wishes were able to make decisions with more confidence and with less fear and had more positive and collaborative relationships with medical staff and with each other.

If you are uncertain how to begin these conversations, there are a few simple questions you can begin asking yourself:

1)     • Who would I want to make medical decisions for me in the event I am too sick or injured to speak for myself?

2)     • Is my main goal to prolong my life, even if I am no longer able to communicate or interact with my loved ones?

3)     • Is my main goal to be comfortable and focus on the quality of my life, even if this means my life may be shortened by not pursuing aggressive medical care?

Sometimes it might be easier to start this conversation with your primary care doctor who can guide you through what the different decisions might look like, based on your health history.

As this calendar year ends and we make plans for 2026, don't forget to begin making a plan for your health and goals of care for the future. A few straightforward conversations can dispel fear and can create comfort and security around a topic that otherwise feels overwhelming.

We are here for you if we can help continue or get the conversations started. Contact us for a consultation.