Each year I write a column about the importance of giving the greatest gift to your family and loved ones, advance planning in the event that you can no longer make your wishes known about what you do or don’t want in regards to your health care. I wish for this repetitive theme to be seen as an opportunity not as nagging.

Bringing up the difficult conversation with your loved ones about how you would like to be treated if you can not let your wishes be known in the event of a life-threatening or end of life situation can be just that — difficult and uncomfortable. However, having a reference to share can be a great icebreaker.


Nathan Kottkamp, an attorney and founder and chair of National Healthcare Decisions Day, founded “Virginia Advance Directives Day” in 2006 to address this very issue. His vision derived from his experiences. In his own words:

“I serve on several hospital ethics committees as part of my health law practice, and I am repeatedly confronted with a very disturbing issue. Time and time again, families, providers, and hospital administrators struggle to interpret the wishes of patients who never made their healthcare wishes known (or failed to complete an advance directive to record their stated wishes). These families and professionals do their best to advocate for what they believe their loved ones or the patient would want or is in their best interests, but they are inherently doing so without any guidance, and it is agonizing. I founded National Healthcare Decisions Day (April 16) because I know that we — both potential patients and healthcare providers — can do a much better job of making our wishes known and then honoring those wishes to avoid these very sad situations.”

National Health Care Decisions Day (NHDD), which started as one man’s efforts in 2006, has grown to the national level and is now an initiative of The Conversation Project since 2016. The Conversation Project exists as a 50-state annual initiative to provide clear, concise, and consistent information on healthcare decision-making.

In 1990, Congress passed the Patient Self-Determination Act. (PSDA) is a federal law, and compliance is mandatory. It is the purpose of this act to ensure that a patient's right to self-determination in health care decisions be communicated and protected.

The Federal Patient Self-Determination Act requires that all Medicare-participating health care facilities inquire about and provide information to patients on Advance Directives; it also requires these facilities to provide community education on advance directives.

All healthcare facilities are required to:

  • Provide information about health care decision-making rights.
  • Ask all patients if they have an advance directive.
  • Educate their staff and community about advance directives.
  • Not discriminate against patients based on an advance directive status.

Despite the efforts of the Conversation Project, the original founder of NHDD, and the congressional mandate (PSDA), the number of Americans who actually have advance directives is alarmingly low.

It is estimated that two-thirds of adult Americans do not have advance directives. Advance directives spell out their wishes for who they want to be their health care representative and a living will, which directs the care they would like to receive in certain situations.

Why don’t people complete this relatively simple task? Some may say they haven’t gotten around to it because they aren’t planning to have any life-threatening health issues anytime soon. (No one wants to think about this, but things happen.) Some think they are too young to have to do this. (The most publicized cases have involved young women who had unforeseen tragedies resulting in lengthy court cases and unspeakable anguish to those involved.) Others put off the task fearing that putting something in writing may mean that their lives may not be saved if there is hope. (The whole point of documentation is to let people know exactly what you want!)

Whatever the reason, the reality is filling out a form will not cause you to have to face difficult decisions one day earlier. In fact your wishes will be on paper to instruct your loved ones on what to do. The last thing anyone wants is someone guessing what you might or might not want. And for many of us in the health care world, the last thing we want is for our most emotional child to be given the heartbreaking decision of “what to do?” Even scarier is for us to think of being dragged through life with no ability to care for ourselves, without awareness of what’s going on in the world around us (except for pain and discomfort) because we didn’t let someone know that we didn’t want this.

The time has come! Get out there and complete your Advance Directives! Use the opportunity in attempt to raise those statistics of the number of Americans or at least Carroll countians who have let their wishes be known.

Carroll Hospital will be hosting a National Health Care Decisions Day — actually two free events — on Monday, April 16 from noon to 6 p.m. and Wednesday, April 18 from 7 to 9 a.m. You will have the opportunity to speak with an outpatient palliative care nurse, receive education on the importance of completing an Advance Directive and receive help filling out the form, which can be placed on file at the hospital. Appointments are recommended but walk-ins are welcome.

The location is Shauck Auditorium, Carroll Hospital East Pavilion, 291 Stoner Ave, Westminster. Call 410-871-7000 for information. And for more information on National Healthcare Decisions Day, go to www.nhdd.org.