To the editor:

An 80-year-old woman develops severe heart problems and is connected to a breathing machine. An 18-year-old man is in a serious car crash and suffers severe brain damage.

What the elderly woman and the young man share is not just a tragic illness and disability, but the need to be prepared.

People are worried about the medical care they might get if they can't communicate their wishes. Some don't want to be dependent on life-support machines, some aren't ready to "give up" just yet. But most wouldn't want to cause distress for their loved ones by letting them guess their preferences for them, with all the guilt and questioning this involves.

A growing number of people are stating their health care preferences in writing, while they are still healthy and able to make such decisions, through legal documents called "advance directives".

An advance directive is your life on your terms. Young or old, documenting your wishes today means your family won't have to make heart-wrenching decisions later.

At its best, an advance directive:

r Names the person you want to make health care decisions for you if you can't communicate your own wishes.

r States any wishes you might have for health care; from maximum treatment, to care only to achieve comfort.

r States those decisions based on personal values.

r Is readily available to health care professionals.

Many think only the chronically ill or elderly need to specify their health care wishes in advance, but every adult needs an advance directive.

Today (April 16) is National Healthcare Decisions Day, a day to focus Americans' attention on making health care decisions in advance.

Completing advance directives is relatively easy. You don't need a lawyer or even a health professional, although a health professional's advice is recommended. To tell a trusted relative or friend what they want in health care is a gift beyond value.

There is a large amount of information available to help with advance directives. Some of the best are advance directive forms themselves, especially the Institute for Health Advancement's, available at www.iha4health.org. Forms like this ask questions about values such as living the longest life possible vs. living a life of some quality even at the risk of limiting one's life span.

Advance directives will help you and your family make the best decisions for you in crisis situations. Fill one out, and give one to your designated proxy and each of your likely health professionals. You'll be glad you did, even if you don't know you're glad.

DAVID A. SHERMAN, R.N., M.S.N., CCRN-CMC

North Shore Medical Center

Salem

(Editor's note: David Sherman works in Salem Hospital's intensive care unit and is a member of North Shore Medical Center's Ethics Advisory Committee.)