Why
a Values History Form?
The
Values History Form recognizes that medical decisions we make for ourselves
are based on the beliefs, preferences and values that matter most to
us: How do we feel about independence and control? About pain, illness,
dying and death? What in life gives us pleasure? Sorrow? A discussion
of these and other values can provide important information for those
who might, in the future, have to make medical decisions for us when
we are no longer able to do so.
Further,
a discussion of the questions asked on the Values History Form can provide
a solid basis for families, friends, physicians and others when making
medical decisions. By talking about these issues ahead of time, family
disagreements may be minimized. And when decisions do need to be made,
the burden of responsibility may be lessened because others feel confident
of your wishes.
How
do I fill out the Values History Form?
The
Values History Form asks a number of questions about issues such as:
Your attitude toward your health; Your feelings about your health care
providers; Your thoughts about independence and control; Personal Relationships;
Your overall attitude toward life; Your attitude toward illness/dying/death;
Your religious background and beliefs; Your living environment; Your
attitude toward finances; Your wishes concerning your funeral. Simply
answer the questions. The form also allows you to record both written
and oral instructions you might already have prepared.
There
are a number of ways in which you might begin to answer these questions.
Perhaps you would like to write out some of your own thoughts before
you talk with anyone else. Or you might ask family and friends to come
together and talk about your -and their - responses to the questions.
Often
simply making copies of the Values History Form available to others
is enough to get people talking about a subject that, for many of us,
is difficult and painful to consider. The most important thing to remember
is that it is easier to talk about these issues BEFORE a medical crisis
occurs. Feel free to add questions and comments of your own to those
already provided.
What
should I do with my completed Values History Form?
Make
certain that all those who might be involved in future medical decisions
made on your behalf are aware of your wishes: family, friends, physicians
and other health care providers, your lawyer, your Pastor. If appropriate,
provide written copies to these people. But remember that each of us
continues to grow and change, and so the Values History Form should
be discussed and updated fairly regularly, as preferences and values
evolve. Consider attaching a copy of it to your Living Will , Durable
Power of Attorney, or Advance Directive for Health Care, if you have
one, or filing the Values History Form with your important medical papers.
Who
should consider preparing a Values History Form?
Everyone.
While it has been customary to focus on older people, it is just as
important that younger people discuss these issues and make their wishes
known. Often some of the most difficult medical decisions must be made
on behalf of these younger patients. If they had talked with families
and friends, these decision makers could feel reassured they were following
the patient's wishes.
What
if I do not have a Living Will or Durable Power of Attorney for Health
Care?
Whether
you sign either of these is entirely up to you, and laws governing these
vary from state to state. For information and assistance, the following
agencies might be of help:
Concern for Dying/Society for the Right to Die
250 West 57 Street, New York, NY 10107
(2l2-246-6973)
This
agency will provide legal information about Living Wills and Durable
Powers of Attorney for Health Care, as applicable in your own state.
Please write to them at the above address. Because of the recent large
volume of requests, expect a 4-6 week turn- around time. If you have
an emergency, you may telephone them, but they caution that it is very
difficult to get through on the telephone.
American
Association of Retired Persons
For a single, free copy of the Health Care Power of Attorney booklet,
please send a postcard with your name and address to: AARP Fulfillment
(Stock No. D13895), 1909 K Street, N.W., Washington, D.C. 20049
You
might also contact your local Office of Senior Affairs, your State or
Area Agency on Aging, agencies providing Legal Services for the Elderly,
or your personal attorney.
We
hope this Values History Form is of help to you, your families and friends.
Many people have commented that it is important to reflect not so much
on "How I want to die," but rather on "How I want to LIVE until I die."
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