By David Lichter
This issue on advance directives is an important one. Many of our NACC members engage daily in the delicate discussion about preparing now for end-of-life decision-making. How critical our members’ intervention is! We are grateful to all who have a role in this process for patients, residents, and their families. We are grateful to all those who contributed substantive articles to this Vision issue. The theme was chosen to correspond with the 2018 National Health Care Decision Day, which is April 16, as NHDD exists “to inspire, educate and empower the public and providers about the importance of advance care planning.”
The November-December Health Progress issue on end of life included an article on advance care planning by two physicians who shared some well-known dramatic data on how few Americans have an advance directive. However, an even more significant statement was:
Facilitating an advance directive, they observe, has moved from a legal process of completing a document to a comprehensive communication process with patients and families to ensure the treatment plan aligns with the patient’s and family’s values, beliefs, and wishes.
They further make the point, which chaplains already know, that “conducting effective advance care planning conversations is a skill. Clinician training will need to begin in graduate school and continue during residency and post-graduate training. For more senior clinicians, instruction in advance care planning can be provided through recertification or continuing medical education.”
I suspect that such a curriculum for clinical training would be similar to much that is covered in the first unit of CPE — training that helps one tend to the other and listen deeply for the unarticulated. But listeners must also face their own finitude and end-of-life issues, whether their own or a loved one’s. These are the skills of all of you, who have been professionally prepared to be with the other in his or her vulnerability.
I wonder how many of our members have educated and trained other clinicians in how to conduct advance care planning? It would be interesting to hear from you. I wonder whether it would be worthwhile to convene via conference call those of you who do so, and whether we could offer the clinical community some leading practices in developing the skill?
Another important question: Have we all, whether alone or with family, tended to this most important task of completing our own advance directive, not as a legal document but as an opportunity for communication? Is yours up to date?
I have updated mine a couple of times, most recently when I had my right hip replaced last May. It was good again to sit down with my wife, Jackie, and together to discuss our end-of-life scenarios and complete our review of our advance directive, along with our power of attorney. Please treat yourself to the process, and be kind and thoughtful to your loved ones in doing so.