Honoring Choices – What Matters Most

Featured Speaker

William Johnston, MD

William Johnston, MD

About this Podcast

About This Podcast

When you are very ill or injured, you may not be able to make health care choices for yourself.

If you are unable to speak for yourself, your doctors may be unclear as to what type of care you would prefer, and your family members may be uncertain or disagree about the type of medical care you should receive.

An advance care directive is a legal document that tells your doctor what care you agree to in advance of this type of situation.

With this document, you can tell your doctors what medical treatment you do not want to have and what treatment you want no matter how ill you are.

William H Johnston, MD is here to explain that at Aspirus we have trained staff to help people discuss their wishes, complete a written advance directive, witness it, and make photocopies.



Melanie Cole (Host):   If you’re unable to speak for yourself, your doctors may be unclear as to what type of care you would prefer and your family members may be uncertain or disagree about the type of medical care you should receive. My guest today is Dr. William Johnston. He’s a family medicine physician at Aspirus Health System. Welcome to the show, Dr. Johnston. So, let’s talk about that. If somebody is unable to make their wishes know and their family may or may not know what they want, what’s the first step in planning this so that doesn’t happen?

Dr. William Johnston (Guest):   We need to make an advanced care plan for that patient. It’s kind of a process that involves, by main objective, to help them go through what their wishes are in the future. You need to understand your health condition and your treatment options at the time and that is sitting down with your physician talking about what kind of medical issues are going on and what treatment may be available to them. Then, you have to figure out from that patient’s point of view what fits with their beliefs and values. So, they weigh their options on that. Then, we need to figure out what a living will means. That’s part of this whole advanced planning process. One of the important things to remember is choosing an agent and that’s the person who will carry out your wishes.

Melanie:   Okay. So, we want to get that living will going and choosing an agent – that’s a family member – but is that somebody you must really trust to follow through with what it is even if they don’t like what it is you’re discussing?

Dr. Johnston:   Exactly. It’s somebody who you have to be very open with and explain what your choices are and you have to ask them, “Will you follow through with my wishes even if you don’t agree with my preferences?”

Melanie:   So, yes, that’s what’s sometimes tough for people. Okay, there are some steps to doing that. You said your first step is to pick that agent and look at your values, look at what it is that you want. Then, is this an actual document?  This living will advanced care planning?

Dr. Johnston:   It is. There is a document that you can have and you can sit down with our experts and go through all of these values and wishes that you have and it can be notarized and have photocopies available to the clinic, to your clergy, your family members and friends.

Melanie:   Dr. Johnston, people hear the words “advanced care planning” and “living will” and they say, “That means that I’m going into hospice or thinking I’m going to die any second now.”  Explain to them how to start that conversation so that it’s not assumed that that’s what’s going on.

Dr. Johnston:   Correct. It is not. We are not assuming that you’re imminently dying. This is something we want to have in place well before it’s a crisis. This is something that people should kind of consider every decade. If you have a death of a loved one, it’s something that might come to the forefront in your mind about, “You know, I don’t think it went as well for them as I’d like it to go” or “These are choices they made that I didn’t want to have done, so maybe I should kind of have my wishes written down.”  If you have a decline in your health, that’s another time to re-evaluate and see if we need to redo an advanced care plan.Melanie:   Tell us, Dr. Johnston, about Honoring Choices at Aspirus

Dr. Johnston:   Honoring Choices is a program that we started in following with the Wisconsin Medical Society. It’s there to help people to talk early and talk often about their healthcare preferences. Originally, we were doing a Thoughtful Thursday Program and this is changing to a new format, a new name, called “Honoring Choices”. The focus with Honoring Choices is to take the time to talk about your past experiences, your values, your beliefs and to encourage people to bring their agents so they can be a part of that process and understand what your beliefs and values and worries are so that they can address those when you are not able to make your voice heard

Melanie:   What a wonderful program. How do people get involved in that?

Dr. Johnston:   Very simple. You can talk to your primary care provider. They have packets in the clinics that you can get involved with or get started with. There is also a helpline that can get you started with this process:   1-800-847-4707.

Melanie:   Now, let’s talk about living wills for a minute and advanced directives. People hear that and they think, “Okay, then if I have a heart attack nobody’s going to come and save me.”  Explain a little bit about how that is not necessarily the case and how you can chose what you want done.

Dr. Johnston:   Absolutely. If you’re a young person and you say, “Boy, I want everything done for me” an advanced care directive or an advanced care plan can say that you want everything done. You do not have to say, “I don’t want to be a resuscitation patient. I don’t want to be put on a ventilator” things like that. You can say any or all of the above. It’s basically just letting people know what your wishes are while you’re still able to make them in case there’s a situation that you cannot have your voice heard immediately.

Melanie:   Dr. Johnston, sometimes people are very pragmatic about this sort of situation and practical and they say, “Okay, I want to discuss this” but their family members won’t hear of it or vice versa. How do you start that conversation?

Dr. Johnston:   That’s the very difficult part with family members getting on board. As a family practice physician, I run into this often with patients that do get quite ill and family members who come in and they haven’t been involved with the whole process and they want to change everything right at the end because they’re not really for their loved one to go. It’s very important. That makes this step--advanced care planning--even more important because it takes the stress off of those left behind and reduces any regrets of people following your wishes. That’s the difficult part when we talk about that with us family practice docs with our patients and the family members.

Melanie:   Do you have some words you can give people to start that conversation?

Dr. Johnston:   I think the easiest way to do it is to say, “You know, I’ve been thinking about what I’d like to have done in case something were to happen to me;  if I get in an accident and I’m not able to speak for myself” and just let people know that you’re thinking about it. This process, these meetings that we have, if you want to bring your family in, that’s a good way to get going but that’s kind of jumping them into the deep end of the pool, sometimes. My thought it to just kind of bring it up and say, “I have thought of what I’d like to have done for me. Is this something that you could follow through with me?”

Melanie:   What’s the difference? People hear living will, they hear advanced directive and advanced care planning. What is a power of attorney for healthcare?

Dr. Johnston:   Power of attorney for healthcare is somebody who is your agent, basically. It is a legal document that states that this person will, hopefully, follow your wishes and that’s the goal of this program. But, they are there to make the medical decisions when you’re not able to make them. A living will is exactly what your advanced care directive is. It is saying what your wishes are so people, hopefully, and this is where your family practice provider and your healthcare providers will help you, stay with your wishes when it comes time when you aren’t able to say your wishes.

Melanie:   Please give your best advice, Dr. Johnston, for people who are trying to work this out with their loved ones or who are trying to come to the decision about an advanced care directive and advanced care planning.

Dr. Johnston:   I would say we need to consider something earlier than later. Again, we don’t want this to be a crisis. We want this to be well in advance. If you do get these done well in advance, an advanced directive or advanced care plan, you can reconsider or reassess this every decade or if you have a death of a loved one and it changes some of your values, then change that advanced care plan so it goes along with your wishes. If you get a divorce, obviously, you want people who are still involved in your life that you want to have with that advanced care plan. If there’s a diagnosis of a serious health condition or decline in your health, you may find that your decisions and priorities change with these changes in life.

Melanie:   Just in the last few minutes tell us once more about Honoring Choices at Aspirus Healthy System.

Dr. Johnston:   It’s a program that will sit down with you with experts. They will discuss your wishes, complete a written advanced directive, witness it and make photocopies of that for you and the clinic. The whole focus is time to talk about your past experiences, your values, your beliefs and what you want done if you’re not able to say things for yourself.

Melanie:   Thank you so much. It’s really great information, Dr. Johnston. Thank you for being with us today. You’re listening to Aspirus Health Talk. For more information on Honoring Choices, you can go to Aspirus.org. That’s Aspirus.org. This is Melanie Cole. Thanks so much for listening.