Who will speak for you if you get hit by a bus?

Advance Directive Form raises tough questions

If you’re like me, you try to control every aspect of your life from what you eat for breakfast to what time you go to bed. You have a system for taking your pills, know what foods you can’t eat, and know just how much medical intervention you are willing to accept.

Does anyone else know these things? Who?

Last week I brought home a health care advance directive form to fill out and keep on file at the hospital. I got stuck on the second question (the one after my name and birthdate): Health care representative. Also called “health care proxy.” This is the person who will speak for you if you are unable to speak for yourself. They will make medical decisions when you can’t. They might literally hold your life in their hands.

I put down my brother’s name, even though he lives far away and doesn’t know all my medical quirks. He cares and he’ll be here if needed. I think. But when they asked for two alternates, I got stuck. My family is not close. The only friend I trust that much would not be able to get to Oregon because of her own health and financial constraints. My friends around here are terrific, but do I know them that well?

The form asks for your wishes about CPR, tube feeding, ventilators and such. How far do you want doctors to go if there’s no hope of returning to life as you knew it before? Doctors are bound to respect those responses.

But I know from experience with my husband and parents that there will be many other decisions where the answers are much less black and white. Should they have this procedure? Should they continue physical therapy? Should they get their teeth fixed or their eyes checked? Should they go to a nursing home? Which one? What happens when their insurance runs out?

Will your representative make sure the facial hair you so carefully eradicate doesn’t grow out and turn you into the bearded lady? I’m blushing as I write this, but I’m not the only one who worries about that. Will they remind people that you have restless legs and are lactose intolerant? Do they even know that?

I’m sure you have your own concerns.

Your health care rep might decide on the types of care you receive, where you receive it, and whether you go home or to some sort of care facility after a hospital stay. They will oversee your medical and hospital records. They might even be asked to decide about what happens to your body after you die if you have not expressed a preference about donating organs or burial vs. cremation.

In choosing a health care rep, you need someone who will:

• Be assertive with doctors, nurses and other healthcare workers.

• Ask the necessary questions

• Be able to speak realistically about death

• Live nearby or travel to be with you

• Respect your decisions and honor your requests, even if they disagree with them

• Know you well and understand what is most important to you

• Share your religious and moral values

• Make the tough decisions, even if it means you might die

• Deal with conflicting opinions from family members, friends or health care providers.

You need someone whom you trust with your life. Who do you trust that much? My quick answer is no one, but when it hits the fan, we have to trust someone. I relearn that lesson every time the orderlies roll me down the corridor for surgery (all minor so far), as well as every time I board an airplane.

Writers at a website called Compassion & Choices suggest that sometimes it’s better to ask a nearby friend whom you trust instead of a distant family member who barely knows you. You could also ask a neighbor or a church member. The local senior center or senior care agency might provide volunteers or geriatric care managers. You could even hire an attorney versed in elder law. There are plenty of people you can pay to do it, but how well do they know you?

If you're like me, you want it to be a close family member, but many of us just don’t have those people. Staring at the blanks on the page, I thought how easy this would be if I had a traditional family. List the husband as first choice, kids and siblings as alternates.

Many workers in the health care world don’t seem to realize that the hardest question on the form is not whether or not we want to be on a ventilator (no thanks) but who will speak for us in a pinch.

This is hard. It shines a glaring light on our aloneness. But it’s important. If you don’t have an advance directive (also called a living will) and a health care rep, decisions may be made by family members or medical professionals who don’t really know what you want.

Just get the form and do it, even if you’re young and healthy, because anything can happen. Your healthcare provider has the forms, or you can download them at https://www.aarp.org/caregiving/financial-legal/free-printable-advance-directives. The AARP list only covers the United States. If you live elsewhere, I’m sure you can find similar sites.

Before you go writing someone's name down, you need to talk to them. Make sure they’re willing to take on this responsibility. Maybe you can be health care representatives for each other. Don’t expect them to remember everything. Write down your wishes and concerns, along with the names and numbers they will need. Who are your doctors? Who is your insurance provider, and where are your cards? Without written permission, privacy laws will make it difficult for them to find out anything.

This decision need not be forever. If you decide your original choice isn’t going to work, or they’re no longer able to do the job, just fill out a new form.

This is one of the hard parts of living alone, but we can do it. Once we figure out what will happen when something goes wrong, we can relax and enjoy our days knowing everything is taken care of. In fact, we’ll be better off than the folks with big families who don’t make the effort to plan ahead.

Your turn: Do you have an advanced directive and a health care representative? Who do you trust to make medical decisions for you? Let’s talk about it in the comments.

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Thank you for your terrific comments on last Saturday’s post about when it’s time to stop living alone. Keep them coming. I promise to write about a lighter topic soon.

I am still offering print copies of my early book Shoes Full of Sand for $5 to anyone who asks for a copy in the comments. You can also buy the Kindle version for $2.99.

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How did I end up alone? My first marriage ended in divorce. My second husband died of Alzheimer’s after we had moved to the Oregon coast, far from family. I never had any kids, only dogs. Now I live by myself in a big house in the woods. You can read our story in my new memoir, No Way Out of This: Loving a Partner with Alzheimer’s, available now at your favorite bookseller. Visit https://www.suelick.com for information on all of my books.