Advanced Planning Provides Peace of Mind for Patient, Family

Action taken today can greatly impact long-term care tomorrow

DAYTON, Ohio (December 16, 2013) – Any adult can be faced with a serious illness or accident that leaves them unable to make decisions for themselves. It’s a reality that no one likes to think about, but a scenario for which everyone over the age of 18 should prepare, said Angelia Mickle, certified nurse practitioner at Jamestown Family Medicine.

“The majority of adults don’t think about this, but as soon as you are an adult you need to create your advance directives because something can happen at any time,” Mickle said. “These direct others to the wishes you want carried out if you become terminally ill or suddenly face death. When you are able to write down these instructions – such as whether you want to go on life support or be artificially supported by medication – it takes so much stress off your family.”

Advance directives – which usually include a living will, a healthcare power of attorney (HCPOA) and may include a do not resuscitate (DNR) order issued by a physician – are documents that give instructions about future medical care and treatment that an individual wants in the event that they become unable to communicate. The living will instructions take effect when a person is terminally ill or permanently unconscious. The living will supersedes the wishes of family members during the time of crisis and helps reduce confusion or disagreement. The HCPOA designates another person who can make healthcare decisions when a patient is unable to communicate.  The DNR order (which may only be issued by a physician) is sometimes used for patients who are already frail and for whom attempts to revive them would probably not result in a good quality of life.

Mickle knows first hand the importance of advanced directives. Mickle’s mother had advanced chronic obstructive pulmonary disease (COPD) at age 71 and was very clear to Mickle that she never wanted to be intubated or placed on life support if such a crisis should ever present the option. Mickle – one of three daughters – was the only child her mother had confided in about this request and she never shared with any of her physicians.

Two years ago, Mickle and her family went on a cruise, leaving them out of touch with family for several days. Within that same time period, Mickle’s mother experienced a bleeding ulcer that landed her in the hospital and a coma within 48 hours. Mickle’s two sisters were left not knowing what decisions to make regarding their mother’s medical care. They decided to have their mother placed on a ventilator, unaware of her desire for the opposite. Within three days, Mickle’s mother passed away.

“I was so thankful that she only had to suffer for three days because her desire was never to be intubated,” Mickle said.

Advance directives are not that difficult to understand or to obtain. Individuals can turn to their family physician for guidance to understand and execute these documents:

Do not resuscitate (DNR) – A DNR order is a written medical order that must be written by a medical professional such as a doctor, nurse or nurse practitioner. This order documents an individual’s wishes regarding resuscitation. It can include as much detail as necessary, such as whether they want to be resuscitated by artificial breathing or by pumping the chest to help the heart beat or even use of chemical drugs. Most local emergency medical services provide free containers so that the document can be held and stored in the refrigerator. A sticker is then provided for the outside of the refrigerator so that EMS crews are alerted to the DNR if they are called to an emergency.

Healthcare power of attorney – This is a person designated to handle all medical decisions for an individual who is unable to do so. A general power of attorney is not to be mistaken for the healthcare power of attorney. Only a healthcare power of attorney can make decisions about a person’s medical care. A general power of attorney, on the other hand, can only make decisions about a person’s estate or financial affairs.

Living will – This ensures that a person’s desires are known regarding whether they want to be kept alive using artificial means, if they become terminally ill or permanently unconscious. The living will may also specify whether the person would like to donate organs from their body, or the entire body itself, upon death. If the person has not done this through the Ohio Bureau of Motor Vehicles or through the State’s online registry, or through creation of a living will, then the decision to donate is left up to the immediate family upon death. According to the Ohio Organ Donor Registry, one organ and tissue donation can save up to eight lives and improve the quality of life for 50 individuals.

Talk to your primary care physician, who can help you and your family prepare these advance directives for future reference. To obtain one or more of these records and begin creating your advance directives, visit A link to the left of the page called Your Health will go directly to these documents once clicked. To find a physician with which to discuss advance directives go to

Contact Us

Discover more about Premier Health and join us in building healthier communities in Southwest Ohio. Learn more about working at Premier Health, becoming a volunteer, and making a gift to support our mission.