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Advance directive recommended for all over age 18

Imagine you suddenly became incapable of making healthcare decisions. What would your desires for your care be?

All residents of Wisconsin over the age of 18, are encouraged to think about their answer, since Wisconsin is not a next-of-kin state. That means, if a person is unable to speak or communicate suddenly, the medical staff cannot go to spouse, children or other family members for decisions.

Community Ed teamed up with Michelle Wiensch, registered nurse at Marshfield Clinic in Cornell, to host a class for people to fill out an advance directive, Nov. 6.

Wiensch says physicians are becoming more aware that Wisconsin is not a next-of-kin state, after a number of lawsuits.

“You get an appointed guardian of the state,” said Wiensch. “And if your family wants to make the decisions, they have to go to court, which can take up to three months and up to $4,000 to be appointed guardian.”

Wiensch said an advance directive can include a living will and designating a healthcare agent, who would make decisions on behalf of the person deemed by two separate physicians unable to make their own decisions. If the ability to communicate is regained, the document is deactivated.

Wiensch says advanced care planning starts with conversations with loved ones and healthcare providers about end-of-life decisions, and hopes and goals for future healthcare. She added that the conversation should be ongoing, as wishes change when circumstances do. The document also helps family members remember a person’s wishes, as grief can make it harder to remember.

“This document helps your family go by what your goals and wishes are,” said Wiensch, adding it also can prevent conflict.

Each attendee was given a packet from Honoring Choices of Wisconsin, which was adopted by most health systems in the state.

“We try to do it, so that no matter where you would go, or end up in the hospital, they would be familiar with the document,” said Wiensch.

She says you keep the original copy and can give copies of the document to whoever you want. The directive also goes on file with your medical provider.

A healthcare agent can also be designated in the form, though no agent has to be named. Up to three people can be named on the form.

“They’re not co-agents, you number them,” said Wiensch.

If the first person is not available by phone, medical providers will call the next person on the list.

“That doesn’t mean they can’t talk amongst themselves, but that initial person would be the decision-maker,” said Wiensch.

Healthcare agents have no control over financial matters.

Wiensh says healthcare agents must be able to support your decisions, even if they don’t agree with them and make decisions in difficult times. Healthcare agents also do not have to be related to you.

“It’s import to talk to the people you have not appointed as your health care agent,” said Wiensch, adding it makes it easier for those people to support those you did appoint.

Wiensch says it is OK to take time to reflect and come back to the questions. She also noted that the document is fluid as the situation changes. Wiensch says people should review their document every decade, new diagnosis, decline in health, divorce or death.

The document has to be witnessed, but does not need to be notarized.

“It’s hard to plan for every situation, because the craziest things happen to us,” said Wiensch.

The document allows a person to mark yes or no to questions, like whether to authorize your agent to admit you to a nursing facility for long-term care, use of feeding tubes or IVs, and make healthcare decisions during pregnancy.

Another section states your desires and care instruction for lifesaving treatments. Boxes later in the document allow a person to specify care instructions and preferences for comfort beyond nursing care, such as favorite music or if you would like warm blankets.

“I may not know you as a nurse, so everything you can think of, put there,” said Wiensch.

There is also a section on organ and tissue donation, and autopsies.

“You don’t really need it, until it’s too late,” said Wiensch.

For more information, free, private appointments are available through Wiensch at the Marshfield Clinic-Cornell location.