A dozen people attended the recent family education group on "Talking Through Tough Medical Issues." Everyone agreed that while modern medicine has worked many miracles, the downside is that end-of-life care often becomes complicated and protracted. Families can be shattered by disagreements over when enough is enough. If a patient is comatose, heavily drugged or unable to speak (i.e. on a ventilator), it becomes extremely difficult – sometimes impossible - to know what his or her wishes are. The group vividly recalled the public nightmare experienced by the family of Terry Schiavo, on life support for years while her husband and parents squabbled over what her wishes would be.

Dr. Jacobs and fellow speaker Mary Ann Mower, a Family Medicine resident at Delaware County Memorial Hospital, strongly made the point that advance directives are an essential document for any adult – particularly those who are elderly or infirm – in order to avoid a Schiavo-like situation and bring peace and cooperation to a family.
An advance directive is a written document that you may use, under certain circumstances, to tell others what care you would like to receive or not receive, should you become unable to express your wishes at some time in the future. An advance directive is often referred to as a “living will.” In Pennsylvania, a living will is known, according to the law, as an advance directive for health care.
This may be the most important piece of paper in your life. If you’ve already written one, where is it? Do your relatives all have copies? What about your physician? It’s fine to keep the original in your safe deposit box, but as Ms. Mower pointed out, it is crucial to have one in an obvious spot in your home as well.
If you have not yet written your living will, help is readily available online at sites like this: http://www.aging.state.pa.us/aging/lib/aging/advance_directives_brochure... or www.caringinfo.com
Or you can hire an elder law attorney who will help you draft and complete a living will.
In a lively, wide-ranging, and informative discussion, the group shared stories from their own experiences and asked specific questions of Dr. Jacobs and Ms. Mower. Ms. Mower gave specific examples of what kinds of questions come up in the hospital setting. She explained that yes, you can change your mind. If your advance directive says one thing but you decide, while hospitalized, to make another decision, your latest judgment will be the ruling judgment – assuming you are of sound mind. Attendees shared personal stories and experiences in a supportive, non-judgmental setting.
Dr. Jacobs is a clinical psychologist at the Crozer-Keystone Center for Family Health in Springfield, PA and author of "The Emotional Survival Guide for Caregivers-Looking After Yourself and Your Family While Helping an Aging Parent" (www.emotionalsurvivalguide.com).
Dr. Jacobs will continue his regular family education group at Plush Mills early in the New Year. Stay tuned for exact dates, times, and topics.