While you may already be observing Sexual Assault Awareness Month and National Crime Victims’ Rights Week this month, you might not know that April 16, 2021, is National Healthcare Decisions Day (NHDD). Since 2008, NHDD has been an opportunity to educate and empower the public and healthcare providers around the importance of advance care planning.
There are many benefits of advance healthcare directives, which allow the person executing the document – the principal – to express their wishes should they become incapacitated and unable to participate in decisions about their care. An advance directive documents the principal’s wishes related to where they will obtain treatment, the kind of treatment they do and do not want, and who – as agent – is authorized to make healthcare related decisions on their behalf. The principal may even specify who may or may not visit them, their spiritual care preferences, and where they would like to stay for end-of-life care, such as a hospice facility or at home.
A properly executed advance directive can offer peace of mind to the principal, as they can avoid unnecessary pain, unwanted hospitalization, or unhelpful procedures. It can also give loved ones peace of mind to know that the principal’s wishes are being followed, avoiding potential confusion or conflict among family members.
On National Healthcare Decisions Day, we at NCALL would like to highlight the role that advance healthcare directives can play in preventing abuse in later life, and provide some resources for further information.
There are many benefits to advance healthcare directives for survivors of elder abuse. The principal can direct their own medical treatment ahead of time, to protect themselves against the abusive decisions of third-parties. The principal is empowered to elect a decision-maker that the principal wants, and can even designate a future guardian. Moreover, family and doctors will know in advance what the principal wants done and can act accordingly, over an abusive partner’s objection. Finally, advance directives are revocable, if the principal is competent, should the principal’s wishes or circumstances change.
Although advance healthcare directives can be beneficial to survivors of abuse in later life, they can present many risks as well. Advance directives give a significant amount of power to the designated agent, especially if the principal is or is perceived to be limited in capacity. There are safety measures that can be incorporated into advance directives, but they are difficult to monitor and enforce, particularly in the context of abuse in later life. If a survivor’s agent is an abusive person, an advance directive may be used a license to exert power and control over the survivor’s life.
For more information about advance healthcare directives, please consider the following resources:
- The National Center on Law and Elder Rights has an excellent issue brief on Drafting Advance Planning Documents to Reduce the Risk of Abuse or Exploitation.
- The California Elder Justice Coalition released a blog post highlighting the importance of advance directives during a pandemic, and the ethnic, racial, and economic disparities in who completes advance directives.
- The NCALL Abuse in Later Life Education Series for Advocates contains a module on Powers of Attorney and Guardianship.
- Finally, The Conversation Project, which leads National Healthcare Decision Day efforts, has an excellent toolkit with links to state-specific resources, and suggestions for starting the conversation about advance healthcare planning with loved ones.
Ann Laatsch, JD, is the Justice System Coordinator for the National Clearinghouse on Abuse in Later Life.