Advance directives communicate important health care wishes


November is national caregiver month and hopefully many of the local caregivers attended Friday’s annual Caregiver Conference hosted by Maui County Office on Aging. If not, put it on your calendar for next November.

As a caregiver or future caregiver, it’s never too early to begin the discussion of your loved one’s end-of-life wishes. While many shy away from or ignore this topic for cultural reasons or because it’s uncomfortable, 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 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 is located at It states that the information provided is general and does not constitute legal advice. It is an excellent place to begin. A brief overview of the questions and answers include:

What do I put in my advance directive?

It is important to include at a minimum:

• Types of treatment you do or do not want performed.

• Preference for the type of comfort care.

• Individual who will make decisions in your behalf (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 the brochure ( Individuals should:

• Complete the advance health care directive form.

• Identify the health care power of attorney(s).

• 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 your neighbor who lives alone and is unconscious. The paramedics perform CPR 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 member was available to share her advance directive. If health care professionals do not have the advance directive, they cannot follow it.

To ensure that advance directives instructions are properly carried out, the document 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 but many wish to share information beyond those two pages with family, friends and health care professionals. This information may include wishes for comfort, treatment, last words to family and friends, and services or memorials.

Regardless of age, use National Caregiver Month as an excuse to download, complete and share your advance health care directive with family, health care professionals and other applicable individuals.

* Heather Greenwood Junkermeier 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.