“The trouble is, you think you have time.” — Jack Kornfield

I know I thought I had time. It’s an illusion I held onto until someone very dear to me suffered a severe brain injury following a series of strokes at the age of 34. Life as he knew it–and life as all of us who love him knew it–changed forever.

A lot of decisions had to be made in the first few days after his strokes and a lot more have had to be made since. Because he was young and thought he had time, my friend never made known what kind of care he wanted in the unthinkable situation he now finds himself, nor who he’d want to communicate his wishes to health care providers if he couldn’t do it himself.

And that’s the crux of the problem. We don’t want to think about these types of things. It’s unpleasant to confront our own mortality, so we rationalize not being proactive about planning for the inevitable by telling ourselves advance directives are for old people. And in today’s youth-driven culture, none of us are old, right?

But here’s the unpleasant truth: Bad things happen to people of all ages. You are never too young to make your wishes known about what you want should a medical crisis hijack your life and whom you would want to communicate those wishes should you be unable to communicate them yourself. It’s not enough to just talk about it, though. You have to document it. Writing down your wishes creates a document loosely referred to as “advance directives,” which simply means you have planned in advance who will direct health care professionals to carry out your expressed wishes.

Creating advance directives can be scary, and not just because of the subject matter. Some of us fear giving up our rights. We wonder who gets to determine if we’re able to make decisions for ourselves and what happens if we change our mind about who we want to be our patient advocate, which is the person we designate to make decisions on our behalf. Here are some important–and surprising–things to keep in mind about advance directives, under Michigan law:

∫ Two physicians must certify you as being incompetent prior to your designated patient advocate having authority to act.

∫ You can override your patient advocate’s decision at any time, even if you’ve been declared incompetent or unable to give informed consent.

∫ You can remove your patient advocate at any time.

∫ If you are brought into the emergency room unable to communicate your wishes, consent is implied until you or your designated patient advocate make an informed refusal of treatment.

∫ Nobody automatically has standing to make medical decisions for you–not your spouse, not your parents, not your child. Should you be unable to communicate your treatment decisions, hospitals will use their own policy guidelines to prioritize who will be permitted to make decisions on your behalf, though these practices may not be legally binding.

∫ Unless you have state-recognized advance directives in place, the person you may want to make medical decisions for you may end up having little or no say in your care.

∫ You can–and should–revisit your advance directives from time to time and change them to reflect your current wishes and life circumstances.

Continuing to live in denial that you don’t need advance directives does a disservice to yourself and those who love you. You are more important than your cash or property, though all of us tend to plan more for who gets our house and money than what happens to us while we’re still alive. The greatest gift you can give your loved ones–worth more than all your possessions combined–is to make your wishes known and to designate the person or people you want to communicate what you want when you cannot.

So what’s the first step? Contact MidMichigan Medical Center-Alpena. They have a wonderful, step-by-step workbook, “Honoring Healthcare Choices: Designation of Patient Advocate Form and Directions for Healthcare.” Just 13 pages long, it is easy to understand.

Take the workbook home, read it over, and start the conversation with your loved ones about what your wishes are. They need to know what you want in specific situations, but they also need to know your overriding wishes about what kind of life-sustaining treatments and procedures you’d want, given the ultimate prognosis of your situation. For instance, you may never want to be sustained on a ventilator, but what if it were a short-term measure to get you through a temporary crisis?

It’s important to understand that health care is ever-changing and improving, so balancing what a good quality of life is to you with the quantity of life possible is a vital part of decision-making. You should consult your provider for guidance regarding any specific concerns you may have regarding how existing medical conditions may impact your desired outcomes.

When you’re done filling out the “Honoring Healthcare Choices” workbook, you are ready to complete the legal document, the accompanying Designation of Patient Advocate Form. Once the form is completed, you should make copies for yourself, your designated patient advocate(s), your loved ones and your primary health care provider before taking the form to MidMichigan Medical Center-Alpena’s Health Information Management Department so that it may be entered into your Electronic Medical Record.

Nobody relishes planning for a medical crisis or end-of-life care. But take it from someone who knows: Starting the conversation about advance directives with those you care about, writing down your wishes, and designating a patient advocate are such valuable gifts you can give your loved ones. Please begin today, as tomorrow is never guaranteed.

For additional information or help answering any questions you may have, contact Ashley Hunt, advance care planning specialist at MidMichigan Health, at 989-839-3167 or ashley.hunt@midmichigan.org.

Mary Eagan is a member of the Planned Gifts Committee for the MidMichigan Health Foundation Development Council serving Alpena.