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Healthy Aging

Riverside Health System Encouraging Community To Talk NOW About End of Life Care

March 22, 2017

As Benjamin Franklin penned, the only thing certain is death and taxes. This week, just before the nation rallies to submit final tax forms for the year, Riverside Health System physicians, team members, social workers and more are banding together to encourage the community to talk about death –specifically how family members want to be cared for at the end of life.

Saturday, April 16 marks the annual National Healthcare Decisions Day, founded by Richmond-based attorney Nathan Kottkamp. This massive public effort, now in its ninth year, helps highlight the importance of advance healthcare decision-making and how to set up an Advance Medical Directive, which outlines end of life medical treatment wishes. "It's hard to think about these things," said Dr. Laura Cunnington, Riverside's Medical Director for Palliative Care and Hospice Services. "The flip side is that it is so much harder if you haven't thought about it and someone has to figure out what they should do for you. You give them a gift by taking that burden away."

Making future healthcare decisions includes much more than deciding what care they would or would not want. And it's not just for older adults. Kottkamp, an attorney with McGuireWoods who specializes in health care law, said the issue of people lacking advance care planning is almost always preventable. "The reality is it's not just end of life care and it's not just old people," Kottkamp said. "The cases that have driven laws are women in their twenties." You could have a heart attack or be in a serious car accident that renders you incapacitated and unable to convey your desires for health care.

According to the Pew Research Center, it's something most of us can relate to. More than 40 percent of Americans have a friend or relative suffering from a terminal illness or coma in the last five years and in the majority of those situations the issue of withholding life sustaining treatment came up. Roughly a quarter of adults are estimated to have Advance Medical Directives completed and in place, said Carol Wilson, Riverside's Director of Palliative Care Services and Advance Care Planning. More so, only half of the adults who have an advanced illness have done the planning. "In general, young people think about it less," Wilson said. "We all like to think we're immortal and this requires us to think about what we want, how we would want to be kept alive, if we would want treatment stopped and under what conditions. The hardest part is often just raising the topic."

Talking about your wishes starts with clarifying what results you would want from your medical treatments, if something happened to you, because sometimes the burden of treatments can outweigh the benefits. No one can decide that for another person unless they have talked about it. That is why it is important to select an agent to express healthcare decisions if patients are unable to speak for themselves.


It is not necessary to use an attorney to complete these documents –often referred to collectively as advance medical directives, living wills or healthcare power of attorney. Free living will and healthcare power of attorney forms and information are available at www.riversideonline.com. Also, every Riverside hospital and physician's office can provide patients with more information about advance directives.

Already have an Advanced Medical Directive in place? Consider revisiting it and ensuring it still reflects your wishes. Advance Medical Directives not only should be done by everybody, but should also be updated and revisited as you age, Cunnington said. "What your Advanced Care Directive says in your thirties," Cunnington said, "could be different if you are in your sixties."


Every family is different. Some are accustomed to talking about death and dying. For those, the conversation may be easier to start. For others, consider the following tips to help start the conversation about establishing your Advance Medical Directive.

1. Piggy-back off of something you see on TV, read or current events. If a medical show has a dangerous medical situation in a plot line, for example, use that as a way to say, "If I were ever in that situation…" to get the conversation started.

2. After a doctor's appointment, tell your family your physician has asked you to talk about it as a way of ensuring all your medical paperwork is up to date. Be sure to say it isn't because of a recent diagnosis.

3. Tell your family you are completing your estate planning and you want to ensure all your paperwork is up to date.

4. Tell your family this is a gift you want to give them and now is the time to do it.


What questions will I be asked?

The first thing to answer on the Advance Medical Directive is naming the person who will be your healthcare agent. This is the person you trust to speak for you, a person who would make decisions as you would.

Who should I name as my healthcare agent?

This part is harder, even though many think it's easily a spouse. The reality is you are asking someone to be responsible for making your medical decisions and someone that close to you may be too emotional during a challenging medical time. Consider someone who could play that role and who will make decisions on your behalf.

Where can I get the documents?

Riverside Health System offers the necessary documents online at riversideonline.com. Once you have completed the forms, you have to sign and date them with two witnesses. They do not need to be notarized.

Where do I store my Advance Medical Directive?

Make copies and give one to your healthcare agent, anyone who is close to you and your primary care physician. Anytime you get admitted to the hospital, you will be asked for this document.