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Why Including an Advance Directive in Your Birth Plan is Crucial

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April 16 is National Healthcare Decisions Day, and after the highly publicized case in Texas involving a pregnant woman placed on life support, it's important that all women consider including an advance directive in their birth plan.

Marlise Munoz was 33 years old and 14 weeks pregnant with her second child when she collapsed with a blood clot in her lung and stopped breathing for an hour. Despite her family's wishes, and doctors' determination that she was brain-dead, she was placed on life support for two months. Officials at John Peter Smith Hospital in Forth Worth said Texas state law required them to maintain life-sustaining treatment for a pregnant patient until the fetus could be delivered. (Life support was eventually disconnected after a state judge ruled in January against the hospital, saying that since Munoz was dead and the fetus itself would never become viable, there was no "life" to sustain.)

An advance directive — a document describing the steps you would want healthcare providers to take, or not take, in the event you cannot speak for yourself — may help prevent a family from going through the same kind of trauma.

"Advance care planning for parents is critically important because sometimes the worst does happen, and having an advance directive can be a powerful tool to ensure that a patient's wishes are honored and to relieve the burden on loved ones," says Nathan A. Kottkamp, chairman of National Healthcare Decisions Day. "Whether parents are having their first child or their last of several, the event is life-changing, and it is a great time to engage in advance care planning."

According to the NHDD website, an advance directive comes in two forms:

  1. A "healthcare power of attorney" ("proxy," "agent" or "surrogate") identifies the person you select to be your voice for your healthcare decisions if you cannot speak for yourself.
  2. A "living will" documents what kinds of medical treatments you would or would not want at the end of life.

An advance directive is not only important during pregnancy; it is also essential to keep accessible and ready for any future instances.

"To be sure, the advance directive may not be needed for the pregnancy, but it will be in place if some health crisis happens later. Furthermore, engaging in advance care planning and preparing an advance directive isn't just for mothers. All fathers should do the same just so that they are prepared," Kottkamp says.

It's also crucial that unmarried couples who are having a baby have an advance directive prepared because in most states, unless the partner is named in a written directive, then healthcare decisions will belong to the woman's relatives.

"NHDD is a great time to engage our own parents and grandparents in advance care planning," Kottkamp says. "Everyone should have an advance directive regardless of age or health status, and NHDD is a perfect time to 'have the talk.'"

To create your own advance directive, visit the official National Healthcare Decisions Day website.

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