A person fills out a 'Advance Health Care Directive' form.
Make your wishes known. (For Spectrum Health Beat)

Last year, doctors in a Miami emergency department were startled when an unidentified, unconscious man was brought to them with the words “Do NOT resuscitate” tattooed across his chest.

The strange case, which was published in the New England Journal of Medicine, created an ethical dilemma.

The tattoo triggered discussion among the medical staff, but it wasn’t legally binding and didn’t have the power to change his treatment.

There is a better way.

Take time now to assign a patient advocate and create an advance directive, advises Spectrum Health Acute Care Department Chief Joshua Kooistra, DO. Then be sure the documentation is readily available when needed.

A patient advocate is an individual you assign to speak on your behalf when you can’t make your own decisions, and an advance directive, sometimes called a living will, spells out details about the kinds of care you do (and don’t) want.

Once you’ve created the documents, be sure family members know your wishes. You might put a note in your wallet listing your patient advocate contact information or keep copies in the glove box of your car. Elderly patients sometimes post “Do not resuscitate” orders on their refrigerator to alert emergency medical responders to their preferences.

Make your wishes known

Unfortunately, there is no national or state database of advance directives, so it’s up to individuals and their family members to be knowledgeable.

When a patient is admitted to a Spectrum Health emergency department, they are asked if they have an advance directive in place, according to Dr. Kooistra. If the paperwork is available, it is scanned into the electronic medical records system so all care providers have access.

“If the patient is unable to provide information, that makes it more challenging,” Dr. Kooistra said.

Without information directing them differently, doctors provide every appropriate treatment based on the situation.

Never too soon

Dr. Kooistra’s experience as an emergency physician helped him understand that it’s not only the sick or elderly who need to plan ahead.

When he started his family, he completed an advance directive and assigned his wife as his patient advocate to speak for him if needed.

“I’ve seen situations where care decisions are ambiguous and family members may fight,” he said. “I thought about who I wanted if I was not able to advocate for myself.”

He knows: Accidents can happen to anyone. At any time.

After initial life-saving treatments, difficult questions about care and quality of life often occur in the intensive care unit, where family members may come to realize that their loved one may not have a meaningful recovery.

“That’s when they ask themselves what the patient would want,” he said.

Understand your options

Only about one in three individuals have an advance directive, and the rules vary from state-to-state.

In Michigan, you can choose a patient advocate by completing a Durable Power of Attorney for Health Care form, which is a legally binding document.

You may also choose to complete an advance directive with detailed information about your treatment preferences. This isn’t legally binding in Michigan, but it can help your patient advocate and treatment team understand your preferences.

Your decisions aren’t irreversible. You can revisit and revise your choices throughout your life and as your health changes.