Behind the Puddle

Sometimes the hardest part of completing an Advance Directive is not finding the form.

It is knowing what to do once the form is sitting in front of you.

A healthcare provider may hand you an Advance Directive during an appointment. You may download one because someone suggested you should have one. Maybe something happened to someone you love that made you realize it was time to think about your own planning. However it arrived, a few pages of legal language can suddenly ask you to make decisions you may never have been invited to think about before.

Who would I trust to speak for me? What would I want them to know? What does comfort mean to me? What would I hope treatment could accomplish? What if I don’t know yet?

Those questions deserve more than a blank line and a pen.

A Companion for the Iowa Advance Directive

I created Walking Through the Iowa Advance Directive: A Planning Forward Client Companion to sit beside you while you work through the Iowa Advance Directive.

It is not another Advance Directive, and it does not replace the legal document you will complete. It is also not intended to tell you what your answers should be.

Instead, the companion slows the process down.

It walks through the different parts of advance care planning and helps you think about what each decision means before you make it. Along the way, there are questions about your values, the person you might choose as your healthcare agent, what meaningful recovery might mean to you, comfort, uncertainty, treatment decisions, privacy, organ donation, signing the document, talking with the people you love, and making sure your completed plan can actually be found when it is needed.

You do not have to know anything about the Planning Forward approach before using it. The questions and guidance are built into the companion itself.

You Don’t Have to Know All the Answers

One of the most important things I hope this resource communicates is that “I don’t know yet” is an acceptable place to be.

Sometimes an unanswered question means you need more time to think. Sometimes it means you need to talk with the person you are considering as your healthcare agent. Sometimes you need medical information from a healthcare professional before you can decide what a particular treatment or possible outcome means for you.

And sometimes the question is legal and belongs with an Iowa attorney.

Planning Forward calls this Guided Access. Good advance care planning does not require you, your family, or a facilitator to know everything. It requires recognizing the question in front of you and knowing where to go for the information you need.

The companion helps you do that too.

More Than Filling in the Blanks

Anyone can work their way through a form and fill in the spaces.

Advance care planning asks something more.

It asks us to consider the person whose life those decisions belong to.

That is why this companion begins before the medical treatments and signature lines. It asks you to think about the ordinary things that make life feel like your life. It gives you room to consider what words such as independence, comfort, dignity, family, privacy, faith, connection, or quality of life actually mean to you.

Those answers do not automatically tell you which medical treatments you should accept or decline.

They give you a place to begin asking better questions.

Use It at Your Own Pace

You can download the companion below and work through it from beginning to end, or use only the sections that are helpful to you.

Keep the current Iowa Advance Directive beside you as you work. Write in the companion. Circle things. Leave questions unanswered. Take it to an appointment and ask your healthcare provider the questions you discovered. Use it to begin a conversation with the person you are considering as your healthcare agent.

And put it away for a while if you need to.

There is no prize for completing an Advance Directive quickly. The goal is to understand what you are saying when you complete one.

If You Want to Go Deeper

This companion is meant to help someone work independently, but sometimes the form opens a much larger conversation.

You may discover that choosing a healthcare agent is more complicated than you expected. You may realize that you know what you don’t want but have difficulty describing what you do want. You may want more time exploring your values, experiences, relationships, fears, hopes, and the things you would want someone to remember about you if they someday had to speak on your behalf.

That is the deeper work of Planning Forward, a human-centered, values-based approach to advance care planning.

If you would like to work through that process with someone, you are welcome to reach out or schedule a Planning Forward appointment. You do not need to arrive knowing the answers. That is part of what the conversation is for.

And if you would rather continue exploring on your own, stay awhile.

I will continue adding Advance Directive resources here on Behind the Puddle, including tools for understanding the documents, choosing and preparing a healthcare agent, exploring values, having conversations with family, preparing questions for healthcare professionals, and keeping your planning current over time.

There will be more places to begin.

One Last Puddle Pause

Before you download the companion, there is one question worth carrying with you:

If someone you trusted had to speak for you tomorrow, what is one thing about you that you would want them to remember?

You don’t need a legal document to begin answering that.

And you don’t need to have the rest figured out before you begin.