Advance directives: Communicating health care wishes

January is national “Get Organized” month. When we think about organizing, pictures of filing cabinets and clean closets may come to mind. But today’s focus is on organizing and communicating later-life health care wishes.

Later-life and end-of-life issues are sensitive topics. Many families shy away from them for cultural reasons. Others ignore it because the thought of losing a loved one is too difficult.

But addressing the topic early can create an atmosphere of calm and teamwork within the family.

One of the most important documents regarding end-of-life issues is the advance health directive. This legal document communicates an individual’s wishes, including the use of pain medications and life-sustaining technology, in the case he or she is unable to make these decisions.

In Hawaii, the Executive Office on Aging in the Department of Health developed a two-page brochure called “Your Advance Directive for Future Health Care.”

The full brochure can be found at It states that the information provided is general and does not constitute legal advice, but it is an excellent place to begin. A brief overview of the questions and answers include:

* Why do I need an advance directive? When an individual cannot communicate his or her medical needs or desires, these decisions are made by family or doctors. This can be very difficult if there is disagreement about a treatment plan or the patient’s wishes are unknown.

* What do I put in my advance directive? It is important to include at a minimum: the types of treatment you do or do not want performed; preference for the type of comfort care; and the individual who will make decisions in your behalf, done through a health care power of attorney.

* How do I create my advance directive? The Executive Office on Aging has included a sample copy of an advance directive with a brochure available at Individuals should complete the advance health care directive form; identify the health care power of attorney or attorneys; properly sign (including witness signings) and notarize the document.

Are there other steps? There are many stories of individuals who have an advance directive, but their wishes are not followed.

Perhaps an ambulance is called to the home of an elderly woman who lives alone and is unconscious.

The paramedics perform cardiopulmonary resuscitation and transport her to the hospital where she is revived and placed on life support.

None of them knew of her advance directive, and no family was available to share it. If health care professionals do not have the advance directive, they cannot follow it.

To ensure that an advance directive is properly carried out, it must be shared with all those involved in an individual’s care. This includes all applicable family members, caregivers, neighbors, doctors and other health care professionals.

The advance directive is a simple two-page document that can make a huge difference in the type of care received.

Many people wish to share information beyond those two pages with family, friends and health care professionals.

The Maui County Office on Aging has adopted a wonderful resource to do just that.

It is called Five Wishes and allows individuals to outline in greater detail the wishes for comfort, treatment and last words to family and friends.

Discussions about end of life are difficult. Many of our local cultures consider this to be a disrespectful topic.

But not discussing the topic can be a source of serious tension and disagreement among those who must make the decisions without guidance.

The 12-page Five Wishes booklet was developed to help families bring up this sensitive topic in a respectful manner that can bring families together.

There are two ways to access this booklet: contact the Office on Aging or visit and click on “Five Wishes.” Website visitors can download a sample booklet or purchase hard copies.

Discussing these topics can create peace of mind for all involved.

It may even help with the new year’s resolution of getting organized.

* Heather Greenwood is with the University of Hawaii Manoa Cooperative Extension, Maui Intergenerational and Aging Programs. Aging Matters covers topics of interest to the aging Maui community and appears on the third Sunday of each month.