| Posted March 6, 2014 | By Starling C. Evins, M.D. | Categorized under Families, Men's Health, Women's Health |

Probably the single most important document you will ever put your signature on is something 80 percent of Americans don't have. It's called an advance directive and it could radically change your life and the lives of your closest loved ones.

By definition, advance directives are written instructions stating your preference for your future medical decisions in the event that you become unable to communicate such decisions for yourself.

Do you know if your spouse wants to be on life support should they end up facing that decision? If you don't know the answer to that, what are you going to tell the doctor if that's a position you find yourself in?

It's not a fun subject to discuss over the dinner table, but it's a conversation that couples need to have — and they need to write it down. And keep it in three places. Because nobody plans to have a car wreck, or a heart attack or any other sudden traumatic injury that could leave you hanging in the balance between life and death, but it happens and all too often future care wishes have not been documented.

In the absence of a patient's written designation of wishes and a surrogate to speak on their behalf, hospitals are required to do everything that can possibly be done to keep the patient alive. This means CPR, feeding tubes, additional medications and constant monitoring that can go on indefinitely. People can be kept alive for long periods of time with zero consciousness.

The document

A legal advance directive document allows you to state your advance care plan or living will and appoint a health care agent or surrogate to make health care decisions for you if you are unable to make them yourself.

The document doesn't go into effect until you are incapable of clearly expressing your own wishes.

Forms are available for download at www.tennessee.gov/health. All you have to do is fill it out, sign it and have a witness sign as well. But the most important thing comes next. If nobody knows you have this document, it isn't going to help you should you end up needing it.

I recommend calling the case management department at whatever hospital you would normally go to and have them file it electronically in your record. Then give a copy to your significant other who you have designated as your surrogate and you need to file a copy for yourself.

Then if for whatever reason you end up at the hospital, your wishes can be carried out. The physician will meet with the family and issue a POST, or physician orders for scope of treatment, that instructs the medical staff to follow your wishes.

Decision day

Without this document, physicians are required to get uniform agreement from all family members before they can start backing off of keeping you alive artificially. But you can imagine how hard that is to do. Even if all your immediate family know that you don't want to be kept alive in the event of a trauma, but your cousin from Peoria shows up and says they think differently, then you have an ethics problem.

What an advance directive does is allows caregivers to give the best care possible up to the end and it allows the patient to die well. It allows nature to take its course so a patient can die comfortably.

Why so rare?

The main reason people don't have advance directives in place is because nobody expects they are going to need them. It's an uncomfortable conversation, but your wishes for end-of-life care need to be shared and documented. Everyone should have an advance directive because the potential for an accident is always there.

Filling this document out and sharing it with family members hasn't become part of normal care, but the feeling is that it should. Physicians should plan discussions about this, but they don't.

It's important to have this done before you become a patient.

We hope it is a document that you never need to execute, but if you ever do need it, it will be the most valuable thing you ever did for your family.