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Advanced Directives: Decisions To Help Those You Live For

Madison Edwards, PA-C

Establish your wishes regarding medical treatment and end-of-life care for security and peace of mind for yourself and your loved ones.

On February 18, the Carter Center announced that Jimmy Carter was entering hospice, stating,  “After a series of short hospital stays, former US President Jimmy Carter today decided to spend his remaining time at home with his family and receive hospice care instead of additional medical intervention. He has the full support of his family and his medical team.”

At 98, Jimmy Carter has achieved the distinction as the oldest living US president after surviving brain cancer in 2015 and enduring other health issues throughout 2019. President Carter is fortunate that he was able to participate in his end-of-life planning and choose spending his remaining time with the comfort of his loved ones.

Tom Sizemore, an actor known for his roles in “Heat,” “Pearl Harbor,” “Saving Private Ryan,” and “Black Hawk Down” was less fortunate after suffering a sudden brain aneurysm following a stroke on February 18 at age 61. After more than a week of lying in a coma in the ICU with no improvement, Sizemore’s manager released a statement that doctors had determined that there was “no further hope” and his family was deciding end-of-life matters.

One of the most important life decisions you may make is the legacy you want to leave for loved ones and your end-of-life plans. Approximately 37 percent of Americans have an advanced directive, defined as a legal document that informs health care providers on what medical treatments you want or don’t want offered should you become unable to speak for yourself. This leaves over 200 million people without any clear plan or guidance for their family or medical provider in the event they are unable to make health care decisions.

Some people like President Carter are able to participate in their medical treatment and end-of-life planning, ensuring their wishes are communicated and honored. Many others without advanced directives can end up in a similar situation as Tom Sizemore, unable to choose to continue or terminate care, leaving the decision to someone else. In situations like these, advanced directives are critical for the comfort and safety of everyone involved.

Advanced directives include two types: living wills and a durable power of attorney for health care or medical power of attorney.

Living Will – A living will details your treatment decisions should you become incapacitated and unable to communicate your wishes directly.

These treatment decisions can include:

  • Placement of life support equipment for organ failure, such as a ventilator
  • Do not resuscitate (DNR) orders to prevent life saving measures should you stop breathing or your heart stops
  • Placement of a feeding tube or IV for nutrition and hydration
  • Medications to ease discomfort
  • Organ and tissue donation

Other decisions can include:

  • Spiritual care
  • Hospice care / home care
  • Allowance or restrictions of visitors

Durable Power of Attorney for Health care or Medical Power of Attorney – A durable power of attorney for health care, also called a medical power of attorney, gives decision-making authority to a person of your choosing to act on your behalf. A durable power of attorney for health care is only active once a doctor determines that you are unable to make health care decisions yourself.

Advanced Directive Benefits

First and foremost, an advanced directive ensures that your wishes are carried out to provide or withhold medical care should you become incapacitated and unlikely to recover. An advanced directive also gives your loved ones the invaluable gift of peace of mind by removing the responsibility of guesswork as to what you would have wanted, especially when they are already in a state of grief and anxiety.

When emotions are running high, advanced directives can prevent conflict between family members over end-of-life decisions.

Implementing an Advanced DirectiveIn South Carolina, if you are 18 or older, you can get an advanced directive. Obtaining an advanced directive is simple, only requiring you download a form online that must be notarized, or you can consult with an attorney if you have more complex needs and concerns.

At HopeHealth, we offer an opportunity for Medicare patients to complete an advanced directive during their annual wellness appointments. We do this by completing a five wishes booklet. These booklets are handed out at the annual well visit appointment and patients have the opportunity to schedule a follow-up visit specifically to review this content. At the five wishes appointment, a provider goes through the booklet with the patient to ensure they have a clear understanding of the information and their contributions. Then, an on-site notary will notarize the booklet, it is scanned into the patient’s chart, and copies are made and given to the patient. This is a great opportunity for HopeHealth patients to get ahead on their end-of-life planning.

Since no one knows what tomorrow may bring, the best time to get an advanced directive is now. Discuss your wishes for care with your loved ones throughout this process as well, to ensure everyone is on the same page.

Become your own health care advocate and utilize advanced directives to ensure you receive the care that you believe is best as you plan for end-of-life circumstances.



HopeHealth educates its patients on the importance of having a health care home. As a primary care facility, HopeHealth’s medical team works to prevent and detect illness and the early onset of disease, provide routine physical examinations and promote overall healthy lifestyles.

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