With all the recent focus on what is now called advance care planning (ACP) in the medical and social work literature, it is important for people, especially middle-aged and older people, to understand what is at stake.
Using the old terminology of a “living well” there has been a transformation from what used to be a few words in a document somewhere or as a conversation with the family member likely to be the substitute decision maker (SDM), that, for example, the parent “would not want any heroics” if developing a terminal illness.
The reality is that it is no longer enough to help those empowered to make such decisions on your behalf. The new world of medicine has many things that can be done that are no longer considered “heroics” but just part of contemporary every day medicine.
So a number of suggestions:
1) make sure your SDM can honestly and emotionally carry out your wishes;
2) try to be specific about those life-prolonging interventions that for sure you would not want–such as a permanent feeding tube if you are not conscious enough to appreciate food or those around you;
3) make sure in addition to writing a document, to have the conversation with those you decide you would like as your SDM;
4) get advice from a trusted doctor and lawyer as what you might want to include and how to frame a document if you want to write one.
