On a hot July day, a group of Cheshire Medical Center patients are sitting in an air-conditioned conference room at the hospital. They’re all mostly over 50 years old, and they’re here for a presentation on advance directives — plus the free pizza that comes with it.
If a person has a health crisis and becomes unable to speak for themselves, it falls to a loved one to make medical decisions for them, but that caregiver might not know what kind of care they would want.
That’s why a team of doctors and social workers in Cheshire County are pushing for more people to complete advance directives — legal documents laying out their healthcare wishes. And they’re helping people get them done on the spot.
The two doctors leading the presentation, Yousef Amr and Cathy Schuman, started by asking what kind of health care the attendees would want at the end of their life. One patient raised her hand.
“I want to make sure that I'm going to have some type of quality of life,” the patient said. “If I'm not, then I don't want to be hanging around.”
That kind of wish is something you can put in your advance directive. The document has two parts: a living will that lays out what kind of care you’d like to receive or refuse, and who should make decisions for you if you’re incapacitated, sometimes called a "healthcare proxy."
For example, a terminal cancer patient might say they don’t want CPR because they don’t want to risk broken ribs or injured organs, or, they could request the opposite: that doctors use all possible medical interventions to extend their life.
Amr said he’s been shocked by how many patients come into his office or the ER without having any care preference documented.
“They’re in the moment of crisis,” Amr said. “And we kind of need to know what their wishes are and who would they want — if things go south — to make those decisions for them.”
In a 2016 survey, 85% percent of American respondents said that when thinking about their own death it was deeply important to them that their wishes for medical care be followed. But only about one third of U.S. adults have put those wishes down in writing with an advance directive.
Dr. Cathy Schuman, Amr’s mentor during his family medicine residency, said she’s had to navigate situations where family members don’t know what care their incapacitated relative wants because none of them have talked about it before.
“It's hard to think about dying,” Schuman said. “It's hard to think about when you're 18 that you might not be around, or even when you're 65 it's still hard to think about [when] you might not be around.”
She and Amr are trying to make thinking about that a little easier by teaching people about advance directives and helping them create their own at the same time.
They’ve teamed up with social workers at Home Healthcare, Hospice and Community Services, based in the Monadnock Region, to hold these sessions across southwestern New Hampshire — at the hospital, in nursing homes, and at community centers.
“I did my advance directive, I believe it was in April, literally in this room,” Laurie Wilcox said.
Wilcox works with Home Healthcare, Hospice and Community Services and was one of the witnesses working the event. Although she had an advance directive done in Connecticut when she lived there, she didn’t know that it wouldn’t necessarily transfer now that she lives in New Hampshire.
“I learned all that information right here in this room,” she said.
She filled one out during the workshop, and also decided to update it with even more details for her children.
“I lost a husband in 2016, and I made a promise to my children that I would do everything possible, since I was the last living parent,” Wilcox said. “To be in a good way for them outward from here. And the fact that I didn't have this [advance directive in New Hampshire] — learning all that information was mind blowing to me.”
Elizabeth Lent and her uncle, Paul Daly, also went over the forms together. He’s 75, and he’s asked her to be his healthcare proxy.
“Who knows, I might be dead tomorrow,” Daly said. “So I want it to be easy for my relatives.”
Lent has had experience with advance directives before when her mother was dying and on life support.
“My mother was on life support and it was really helpful to see her initials next to what she wanted,” Lent said. “And it definitely took the burden of decision making off my plate, which was really helpful.”
Lent and Daly signed their names on the forms, and two Home Healthcare, Hospice and Community Services employees did the same, making it a legal document. It’ll go into Daly’s electronic health record, and now both he and his niece know what he wants at the end.
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