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People of all ages should be talking about end-of-life wishes, Utah doctors say

Doctors from multiple Utah hospitals on Tuesday urged anyone over 18 to talk with family members about what treatment they would like if they are unable to speak for themselves, to establish an advance directive.

Doctors from multiple Utah hospitals on Tuesday urged anyone over 18 to talk with family members about what treatment they would like if they are unable to speak for themselves, to establish an advance directive. (Charlie Ehlert, University of Utah)

Estimated read time: 4-5 minutes

SALT LAKE CITY — Aimee Smith's dad was recently admitted to the emergency room and, as his only daughter living in Utah, she realized she really didn't know what her dad would want if he couldn't speak for himself.

Care workers at the hospital were able to help her have a positive conversation about treatments with her dad.

"It's a hard conversation to have and one that many people are really uncomfortable having. My dad, in particular, has struggled with the reality of his own mortality," Smith said.

She is relieved that now, when something happens again, she knows more about what her dad wants and she won't have to make the decisions herself at a time when she is dealing with heightened emotions. This experience also led Smith to have similar conversations with her children.

Utah doctors on Tuesday urged people to take time to talk about what medical care they would like to receive in an end-of-life situation and develop an advance directive. Such a legal document, they said, would ensure that family and health care providers know a patient's wishes when they are unable to speak for themselves.

Such conversations are difficult to have, but having an advance directive in place makes it easier for families to deal with hard situations, said Dr. Kencee Graves, inpatient chief medical officer at University of Utah Hospital. She said these conversations are a way of protecting loved ones and preparing them to be your voice.

"For families that I have worked with, it is the least difficult when they know what their loved one, who is sick, would want," Graves said.

An advance directive, she said, dictates who speaks for you when you can't speak for yourself — including what quality of life looks like for a patient and how health care decisions are made regarding specific situations.

"An advance directive makes it much, much easier to see someone's voice," Graves said.

National Healthcare Decisions Day is on Saturday, and doctors with University of Utah Health, Intermountain Healthcare, MountainStar Healthcare and Steward Health Care said they hope people will take an opportunity this week to talk about their wishes.

When doctors are not aware of what a patient may want — when they don't have an advance directive — doctors will use aggressive treatment to keep the patient alive. They also use a state-created hierarchy to determine which family member should make decisions.

A combined statement from the Utah health care systems states that everyone over 18 should have an advance directive, which they can give to family members, their doctor and the hospital. It should be reviewed at least every year.

Dr. Dominic Moore, Intermountain Healthcare medical director of palliative care, said an advance directive should be considered a living document, and that families should discuss how it could be changed with a new diagnosis, a decline in health, a divorce or a death in the family.

"Advance care planning allows for a person to make sure that their voice is heard, to make sure that their family is cared for, and to make sure that they're prepared for all needful things," Moore said.

Moore explained that for children under 18, their parents make decisions, but that healthcare professionals try to make sure that everyone has a voice, particularly children with chronic illnesses. When conversations like this have already happened, Moore said, it allows families to focus on supporting each other in hard times instead of balancing tough decisions.

He said planning for something like this does take some imagination, but the COVID-19 pandemic may have made it easier for people to imagine themselves in a state where they wouldn't be able to speak for themselves since many people know someone who was hospitalized during the pandemic.

"I think that, unfortunately, we've all been touched by illness in that way. But hopefully, we take from that the learning and the benefit and the ability to imagine ourselves in all different health states," Moore said.

Dr. Steve Cherrington, with MountainStar Healthcare, said that when there is no plan, they see a lot of grief and hurt from the family that is left behind. He said there are many forms that can be found online to help people know what needs to go into their advance directive. He said creating an official advance directive is ideal, but it can sometimes be enough to sit down with family and caretakers and talk through possible scenarios.

"You're not too young to talk about this," Cherrington said. "These discussions really need to be taken on very early."

Dr. Arlen Jarrett, chief medical officer for Steward Health Care Utah Region, said at their hospitals, new patients are asked whether they have an advance directive, and they help people who do not. However, he said they still have many people who are not prepared when they are unable to speak for themselves.

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Emily Ashcraft joined as a reporter in 2021. She covers courts and legal affairs, as well as health, faith and religion news.


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