By Judith Parnes LCSW, CMC 

Advance Directives have been widely viewed as the cornerstone of advance health care planning. They encompass both instructions about what kind of care can be provided and who can make the decisions if the individual can no longer do so. The federal Patient Determination Act of 1990 required facilities that participate in Medicare or Medicaid to offer patients information about advance directives. Subsequently, state laws regarding Advance Directives were enacted. 

It was believed that the ability to appoint and plan in advance for your future health care treatment would revolutionize how medicine was going to be provided. It was thought that by use of these legal documents, the patient would be able to express a general philosophy of “end-of-life care.” However, this has not been the reality. Advance Care Planning involves more than naming a health care proxy or filling out a form. It is a process that ideally begins with physicians helping patients to articulate and prioritize their goals of care. For individuals and their families in the midst of acute illness, making decisions regarding alternative treatments is easier if it takes place within the context of a previous discussion of the goals of treatment. 

Slow Medicine is an approach to care over many years of late life that emphasizes careful and reflective decisions, which help to set the tone for more complex end-of-life decisions. It encourages useful diagnostic and therapeutic choices, but discourages use of aggressive, difficult, and costly procedures, which cannot stop the inevitable decline of advanced age. What this means is GCMs can now play an instrumental role in facilitating the conversations necessary regarding Slow Medicine and an individual’s inclusion of this philosophy in their later life plan. Adding information to an Advance Medical Directive including language about Slow Medicine philosophy can therefore be of assistance to surrogate decision makers in the future. 

How the GCM facilitate this:  

  • become comfortable with Slow Medicine philosophy  
  • understand your client’s values and wishes  
  • have established a relationship of trust with client  
  • educate the client and family on Slow Medicine  
  • coordinate family dialogues  
  • initiate the “talk” with the physician including the groundwork for future care  
  • participate in physician meeting(s) to discuss future treatment plans  
  • be knowledgeable about state-specific advance medical directive statutes  
  • review documents and assure language includes client’s wishes  
  • support the client and family during end-of-life process  
  • refer for Hospice and Palliative care as needed  
  • be familiar with hospital and community ethics committees for problem resolution  
  • advocate when necessary and be the voice of reason 

Philosophy and quality of life are terms that are very difficult to equate with a document that provides detailed “instructions.” With many Advance Medical Directives applying only to “terminally ill” patients or individuals facing imminent death, this tool alone is often times of little practical use for advance care planning. End-of-life decision-making at the hospital bedside typically does not work. It is not unusual to see families outside the ICU crying, screaming, and threatening. This is the time when families need to be offering each other support; however, it can become the unfortunate time for hostility and court rooms. 

Palliative care maximizes the provision of comfort measures regardless of terminality. It is important not to confuse the slow medicine philosophy with Hospice or Palliative care. While both focus on relieving symptoms of chronic illness, palliative care can include life-sustaining treatment. Slow Medicine is about planning ahead, and knowing how you want to live…not about how you want to die. 

Physicians do take seriously their obligation to engage patients in decisions about their health care; however, sometimes they need the care manager advocate to initiate the “talk.” GCMs do make a major difference in the care and treatment of our individual clients. If we all added the Slow Medicine component to our trainings, think of how many more people could be educated to this philosophy. Maybe then the Patient Determination Act signed into law more than 20 years ago will make the impact that was intended when legislated. You may visit for free state-specific Advance Medical Directives.

Advocare Care Management is the preeminent organization to help you with the end-of-life issues for elder care in Palm Beach, Miami-Dade, and Broward counties. We offer you complete resources to assist you in dealing with the end-of-life issues. Our team helps countless families and their relatives to effectively manage these issues. We understand the challenges you are facing and are here to help. Contact Advocare Care Management today. 

Reprinted with permission from Advocare Care Management is the place to go when caring for an aging loved one.