Updating Healthcare Directives
It’s always a good idea to look at your estate planning and advanced healthcare directive documents every year. Things can change over a year: your health or financial situation may change, someone listed in your documents may pass away or move, or your attitudes about a particular procedure or intervention may change. So take a look every year and make sure your documents still align with your wishes.
Estate planning usually is understood to refer to your finances and your property – what is considered your “estate” when you die. You should certainly review your will and other estate decisions yearly to make sure you are leaving your wealth to the people or organizations you wish to have them.
But another important aspect of estate planning is your advanced healthcare directive, also called a “living will.” Your living will allows you to specify:
- Whether or not you want life-sustaining medical care, what kind, and under what situations
- Whether or not you want to donate your organs or tissues, if you are a candidate
- What you consider your acceptable quality of life
- What comfort care you would like provided
- Any other instructions you would like followed, regarding moral, religious, or ethical considerations
- What family member(s) or friend(s) will be responsible for carrying out these directives if you are unable to make these decisions for yourself (your medical power of attorney)
When you first created your living will, you probably went over these questions thoroughly and gave them a great deal of thought. Over the course of the year, however, you may hear of new medical technology that you do or don’t want; you may change your mind about whether or not you’ll donate your organs; you may lose a family member who was named as a medical power of attorney.
For instance, maybe you have a friend who benefited from a ventilator during Covid-19, giving your friend time to recover. If you said “no ventilators” in your living will, you may want to modify that directive, such as adding “if there is no expectation of recovery.”
You should also have another conversation with your medical power of attorney and alternate powers of attorney. It’s a good idea to have two other people mentioned in case the primary person is unavailable in an emergency or passes away before you’re able to change your living will. Discuss your preferences and make sure the people you have named still hold the same views you do and will carry out your wishes.
Updating your documents yearly will ensure that your wishes will be fulfilled, if you are ever unable to speak for yourself.
What Is Nicotine Replacement Therapy?
If you are a smoker and you want to stop smoking, we at BCHIP applaud your decision. Smoking and other nicotine use cause a wide variety of serious health problems throughout the body. The statistics are sobering:
- Cigarette smoking increases risk of death from all causes in both men and women
- Smoking is a factor in many different types of cancer
- It increases risk of developing lung cancer 25 times and causes 90% of lung cancer deaths
- Smokers are 12 to 13 times more likely to die of COPD
- Smoking increases risk of coronary heart disease and stroke, the two leading causes of death in the U.S., by 2 to 4 times
- It damages blood vessels, increasing the risk of blood clots that can reduce blood flow to the brain, legs, and skin
- Smoking harms nearly every organ of the body
- Smoking can reduce fertility and cause low birthweight, miscarriage, birth defects, ectopic pregnancy, and stillbirth
- Smoking has been found to affect bone health in women
- Smoking damages teeth and gums and can cause tooth loss
- It can damage your vision and increase risks of blindness, cataracts, and macular degeneration
- Smokers are 30%-40% more likely to develop type 2 diabetes and are more likely to experience complications from the diabetes
Besides these very serious health risks, smoking discolors teeth, causes bad breath, and leaves your clothes smelling like smoke. It can also trigger asthma or other problems in those you love who frequently breathe in second-hand smoke.
So there are many very strong reasons to quit smoking, but because nicotine is addictive, it is extremely difficult to break the habit.
There is also an emotional component to cigarette smoking that needs to be addressed. It helps to have a support system like our free Quit Smoking / Tobacco Cessation Program that will help you stay on track and successfully quit. Nicotine Replacement Therapy (NRT) is available for those who qualify. This five-session program is available both in-person and virtually.
Nicotine Replacement Therapy
NRT supplies low doses of nicotine in order to cut down on cravings for nicotine, lessen physical withdrawal symptoms, and help the person more easily quit. It is especially helpful for those who smoke heavily. The more nicotine coursing through your system, the more difficult it is to overcome the addiction, and many people need the help of NRT to successfully break the habit.
NRT does not contain many of the toxins found in cigarettes or other nicotine products. NRT comes in many forms, including gum, inhalers, lozenges, nasal spray, and skin patches. Patches and gum seem to be the most effective because people are more likely to use them properly. Discuss with your doctor which form may be best for you and what dosage you may need.
Nicotine use can cause side effects, and NRT is no exception. Since the nicotine dosage is low, the chances of side effects are small, but you may experience headaches, nausea or other digestive problems, and difficulty sleeping (usually with the patch, and usually only the first few days).
It is very important NOT to smoke while using NRT. The combined nicotine level could be quite high, causing increased toxins in your body.
NRT is not enough
As mentioned, there is an emotional component to smoking addiction that needs to be addressed in order to successfully kick the habit. Our program will provide you with proven techniques as well as emotional support and mutual encouragement as you face this challenge with others. Visit us at bchip.org/quit-smoking-programs today for more details and to register.
When Family Members Won’t Get Vaccinated
During the last two years, we have seen many Bucks County families divided over Covid vaccination status. Suppose you’re immuno-compromised and you feel unsafe around people who have not received a vaccination or who may have any kind of cold or illness. You have the right to advocate for yourself within your family, and you may decide not to see certain family members for the time being.
Short of serious health concerns, however, try to handle this difference of opinion as you would handle most other strongly-held differences, such as religion or politics: with respect and patience.
One-on-one conversations are preferable, so the other person does not feel ambushed. You will also have more control over the situation because if you want to be calm and patient but someone else who holds your opinion is more hot-headed, the conversation can actually be counter-productive.
That said, if you know the conversation is likely to get heated or emotional, ask a level-headed person whom you both respect to moderate. If it begins to get intense, take a break.
Try to maintain neutral, non-aggressive, and non-accusative body language, tone of voice, and word choice. Don’t say things like “You obviously don’t care about others.” Ask, rather, “What thoughts do you have about how your decision impacts others?” That may still be a difficult question to hear, but it assumes the other person has thought about it, which is a respectful assumption, and it opens up the opportunity for the other person to explain his thoughts on the matter.
Try to explain your position without being preachy. Stick to what you see as the facts and ask your family member to do the same. Facts should be supported by reliable sources. Try not to dominate the conversation. If necessary, set a timer to give each person five minutes of uninterrupted talking, and take turns.
Go into your conversation with the mindset of creating peace and making progress in your understanding of each other’s position. You may both find common ground and even come closer together in your views.
In the end, family is family. Do whatever you can to maintain that mutual love and respect that all family members deserve. You can’t control other people’s actions, but you can control your own. For your part, try to maintain that sense of family bond. Even if there is tension for a time, try to keep lines of communication open so your relationship can continue moving forward and eventually move past this difference.
Whom to Leave in Charge of Your Care: Choosing your Medical Power of Attorney in Bucks County, PA
An estimated 75% of all Americans will at some point be in a medical situation in which they cannot communicate their wishes. While it isn’t pleasant to think about and the conversation may be awkward, it’s important to take time to develop an advanced medical care plan, including a medical power of attorney, in case an accident or unexpected health condition leaves you suddenly unable to make decisions for your own healthcare. Having someone to advocate for you and your wishes is critical when you can’t advocate for yourself.
PA Law and health care decisions
Pennsylvania does have a standard hierarchy of authority that it follows if an adult is unable to make health decisions and has not named a healthcare agent. Healthcare providers will turn to others for guidance on your care in the following order:
- Your spouse
- An adult child
- Either of your parents
- An adult sibling
- An adult grandchild
- A close friend
If the prior person is not available (for instance, if you have no spouse) medical personnel will go to the next available person for guidance (in this case, your adult child).
But what if you have more than one child, or your spouse or children have different views on healthcare than you do? Naming your medical power of attorney solves this problem.
What a medical power of attorney does
A medical power of attorney goes by a number of titles: healthcare power of attorney, durable power of attorney for healthcare, and healthcare proxy. These titles all designate a person who will make healthcare decisions when a doctor determines the patient cannot make decisions for himself. This may include when the patient is in a coma, is taking necessary medication that impairs judgment, or is suffering from cognitive decline or dementia.
Those decisions may include:
- Consent or refusal of medical treatment
- Choosing medical personnel – doctors, therapists, etc.
- Admission and discharge from medical facilities – hospital, nursing home care, etc.
- Access to medical records
- End-of-life decisions, donation of organs
Choosing your medical power of attorney
It can be difficult to choose your healthcare proxy, especially when you have children who are all close to you and to each other. You don’t want feelings hurt, but you do want to choose one person to make the final decisions.
Choose someone who is available, lives nearby, and is levelheaded. You want someone who has similar views as yours and who will follow your wishes. If you want to be kept alive using all measures, then knowing you have chosen a loved one who holds that same belief could be comforting. But you should also choose someone who will not take the power upon himself or herself and exclude family members.
Whomever you choose, it is important to have at least two other people who are alternates. It is not uncommon for people to simply designate a spouse as power of attorney and then become widowed. Without an alternative person designated, you will be without a voice if something happens to you before you get to designate a new proxy.
For your own peace of mind and to ensure that your wishes are fulfilled, take the time to choose a medical power of attorney and two alternates, and make sure all your children and close relatives have a copy of this information. It will be a comfort to you and all your loved ones if the day comes when a medical power of attorney is needed.
Should I Vaccinate My Child? – We Can Help
Here in Bucks County, PA, and all over the world, childhood vaccinations have saved countless children from suffering and death due to severe childhood diseases. The cases of measles, mumps, rubella, chicken pox, polio, whooping cough, and other serious childhood infections have practically disappeared, thanks to these childhood vaccines and improved healthcare.
However, some people have come to the conclusion that since the diseases are now quite rare, the shots are no longer necessary. Because of this, the illnesses are making a resurgence in some areas. For instance, while measles was declared eradicated from the U.S. in the year 2000 by the W.H.O., since 2010, hundreds of cases a year have occurred, with more than 1200 in 2019.
Parents should talk to their children’s doctors about the necessity of childhood vaccinations. The most important childhood vaccines have been in service for decades, and throughout that time, medical teams have been continuously monitoring and improving them. These include:
- DTaP, which protects against diphtheria, pertussis (whooping cough), and tetanus
- MMR, which protects against measles, mumps, and rubella
- Hib, which protects against a type of bacterial influenza occurring mostly in infants and young children
- IPV, which protects against polio
The recommended childhood vaccine schedule is designed to provide immunization when the child’s immune system can best support the action of the vaccine. However, this can be adjusted as necessary, specific to your child’s needs, with the consultation of your doctor. For instance, if your child is ill during the time when a vaccine would normally be administered, the CDC recommends delaying the vaccine until your child’s immune system is again working robustly.
If your child is immunocompromised, talk to your doctor about the best steps to take for each of the vaccines. Your doctor may recommend a delay of one or another type of shot until your child is stronger.
Most childhood vaccines have few if any complications. Occasionally a vaccine may cause a sore arm, redness, crankiness, or a low-grade fever. Your doctor will inform you of what to expect and what symptoms may be of concern, necessitating a call to the doctor’s office.
The likelihood of a serious reaction to these long-standing and proven childhood vaccines is minute, while the complications from the diseases themselves are severe. Only just a few generations ago, most families experienced the sorrow of losing a child to one of these devastating diseases.
We at BCHIP are here to help you make an informed decision to protect your children and other children from these serious illnesses. If you do not have a doctor for your child, contact us to answer any questions and help direct you to an excellent doctor in your area.
When a Loved One Won’t Stop Smoking
If you have a loved one who can’t or won’t stop smoking, you’re both in a difficult position, but it’s not hopeless. Smoking is an addiction, not unlike alcohol or other substance abuse. The addiction makes it very difficult for the addicted person to realize he has a problem in the first place, want to quit, and successfully kick the habit.
Just as with other addictions, your loved one has to first admit he has a problem. Once he recognizes that his smoking is a problem, he needs a successful plan and a supportive team in order to successfully quit.
You may have very valid objections to his smoking: you may have a baby, a compromised immune system, or allergies, or you just think it’s a gross habit. But these are your objections. The smoker needs to find his own internal motivations to outweigh the pleasure or benefits he experiences from smoking.
For instance, some people smoke to help calm down and manage stress. Others may have started smoking as an act of rebellion or “growing up” or to fit in with a group, and although they may have outgrown those reasons, subconsciously the memories remain. But ultimately, they still smoke because their bodies are now addicted. It will take not only willpower but possibly some medical intervention to help your loved one quit, if and when he decides to quit.
Helping your loved one want to quit
The decision to quit smoking is highly personal. Don’t shame, preach, tease, or shun your loved one because of his choice. If you have children or your own health issues, you have the right to insist that your loved one not smoke in your presence or the children’s presence, but you cannot demand that he change his lifestyle.
Believe in your loved one and always bear in mind that people who cannot stop smoking have both a physical and emotional addiction to it. If, for instance, your husband started smoking at age 15 as a sign of rebellion against overly-strict parents, your nagging will reinforce that negative subconscious memory and make him dig his psychological heels in even deeper. So try to be sensitive to these issues.
Try to talk to him calmly about it. Ask him if he sees smoking as a problem. Ask him what he thinks about all the medical evidence showing that smoking is a major factor in heart disease, stroke, cancer, lung disease, and premature aging. Ask him why he still smokes. Seek first to understand.
If you start by understanding where he’s coming from, you will then be able to present your concerns and objections in a more loving and less offending matter. You can tell him that, even if he is not concerned about the medical issues for himself, you’re sure he wouldn’t want his children to get tar in their lungs from his cigarette smoke, and he certainly wouldn’t want them to pick up the habit and risk their own health, just because they see their dad smoking. Tell him what a great example he would set for them if they see their father stop doing something that he enjoys out of love for them.
Tell him you want to have him with you for many years to come, as a living human being and not just a photo on the mantelpiece. Tell him you know he is strong and can quit if he wants to, and you’re there to help him when he’s ready. If you are sincere, this will give him a boost of confidence, and it puts the ball in his court to decide when he’s ready.
Finally, you may want to enlist the help of his physician. Cold statistics are not as convincing as a doctor in a white coat standing in front of him telling him, “Here’s your health condition, and this is where you’re heading if you don’t quit smoking. It won’t be pretty, and it will be very painful, a lot more painful than the temporary discomfort of quitting.”
If your loved one admits he would like to quit but there are certain situations in which he enjoys a cigarette, for instance, with his morning coffee and when he relaxes after work, ask him if he’d be willing to reduce his smoking to just those two times. An incremental cessation, though more difficult for some people, might work for him. Many people have successfully resisted the urge to smoke during the day by saying, “I’ll hold out until my evening cigarette.” Decreasing gradually can make it easier to quit eventually.
At BCHIP, we have an excellent, free smoking cessation program that has helped countless people overcome the habit. When your loved one seems open to a calm conversation about it, you can look through our program together, promise him he has your support, and ask him to talk to one of our experts to help him take the first steps towards a smoke-free life.
Why Is It So Hard to Quit Smoking?
While many people have successfully quit smoking, they will tell you it wasn’t easy. Many other people – perhaps you – have tried to quit more than once but have not yet been successful. But don’t give up. There are reasons why it’s so hard, and when you address those reasons, you can quit. BCHIP has a free online Quit Smoking Program for residents of Bucks County that will help you address the issues and succeed the next time you try.
Biological reasons why quitting is hard
Most people know that smoking is addictive and that nicotine is the main culprit. Nicotine stimulates the parts of the brain that release chemicals that make you feel good. When you feed your brain nicotine frequently, the nicotine changes the way your brain works, and eventually your brain will need nicotine in order to release these feel-good chemicals. We call this requirement an addiction.
If you don’t have the nicotine when your brain thinks it needs it, you will feel irritable or jittery, anxious or low. You may have trouble concentrating or sleeping. These feelings are what we call withdrawal, which is one of the reasons why it’s so hard to quit. Naturally, in order to feel well again, you will be tempted to reach for a cigarette (or whatever nicotine product you use).
The good news is that, once your brain is starved of nicotine for a few weeks, it goes back to being able to operate just fine without it, and you won’t need a cigarette to feel well or to concentrate anymore.
Social and lifestyle reasons why quitting is hard
The other reason why it’s so hard to quit smoking is because, if you’ve been smoking for a while, you will associate many of your activities with smoking. This includes routine activities such as eating or drinking, work activities such as concentrating on a difficult project or staying late at the office, and relaxation activities, such as hanging out with friends or relaxing with a drink and a cigarette.
An even bigger challenge than saying “no” to your brain is saying “not anymore” to your lifestyle. You’ll have to start doing things differently, and you’ll want to enlist friends and family to help you. You’ll need to change your routines at least a little, so you can send a signal to your brain that “this is new; we’re doing things differently now” and you won’t automatically associate the activity with smoking anymore.
One of the things we teach you in the smoking cessation program is to brainstorm simple changes to your daily rituals. For instance, if you usually sit at the kitchen table in the morning and have a cigarette with your morning coffee, instead try tea or an energy smoothie that wouldn’t taste good with a cigarette. Still want your coffee in the morning? Then change your setting. Instead of the kitchen, sit on the patio. Eat pretzel sticks or baby carrots instead of smoking a cigarette.
The other benefit of our Quit Smoking Program is that we show you how to build support among your friends and family. If your friends are smokers, you’ll need to tell them you’re trying to quit and that you’ll need to back off for a while until you succeed, so you’re not around the smell of smoke. That will be hard, but good friends will support you in this. Your family will also want to help you improve your health by quitting smoking.
Motivation to quit
Another important part of quitting smoking is having a really good reason to do so. Is it because you’re tired of smelling like smoke and having discolored teeth? Is it because you feel like you’re always coughing or catching every illness going around, or because you get winded going up the steps? Or is it so you can be there for your children in 20 years? Pick your motivation and put reminders where you’ll see them.
In the BCHIP Quit Smoking Program, we’ll help you get on track to success, providing education, tools, and the support you need from others who are undertaking the same challenge.
Start today. Register here, or call 267-291-7882.
College Kids and Health Care Directives – What Parents Need to Know
When your child turns 18, he or she is considered a legal adult. If you do not put the right legal documents in place, you lose all rights to know about or get involved in his or her medical care. Even if your child uses your health insurance and even if you pay the bills, according to HIPAA (Health Insurance Portability and Accountability Act) a parent must have an 18-year-old child’s permission to be informed about the child’s health or to make medical decisions if the child is unable to do so.
For residents in Bucks County, PA, we can help ensure that the right legal documents are in place in case you need to get involved in medical care decisions.
Imagine your child is a few states away, miles from home, and is lying unconscious in the hospital. The hospital has no authority or responsibility to contact you, and your child’s roommate, RA, or other school official calls. Unfortunately, it’s too late for your child to sign forms to put you in charge of his or her care.
This is a nightmare situation, which unfortunately happens frequently, even when a child is still in high school and living at home at age 18. But it can be very easily avoided by having your child complete an advanced medical care directive (also called a living will). BCHIP has sample forms to make it easy for you. For a young person, it does not have to be very elaborate.
Your child should complete a medical directive and medical power of attorney and include more than one person, for instance, Mom, Dad, maybe grandmother or grandfather in the event that the parents cannot be reached. The documents should also include HIPAA authorization. The documents need to be signed by your child and the other parties named and signed by witnesses who are not the parties named.
Make copies and supply them to your child’s doctors and school, and keep a copy for yourself. Your child should also have a copy if living away from home. You may wish to have scanned copies or photos on an online document source for easy access in case of emergency.
Hopefully, you will never need this document, but if you don’t have it and your child is incapacitated, you may have to go to court to receive authority over your child’s healthcare. Prevent that nightmare by signing a simple healthcare directive with your child.
How to Talk to Your Children about Your Estate Planning
If you have adult children, the time is now to talk to them about your estate plan, including your Advance Healthcare Directive. While you may expect it to be an awkward conversation, the awkwardness often dissipates once you begin talking things out.
An advance healthcare directive is much like a will, and thus, healthcare planning is much like estate planning. Just as you don’t want to leave the distribution of your remaining assets to chance or leave the kids fighting over who gets what, you don’t want to leave your kids arguing over what medical care you should receive when you are unable to speak for yourself. Therefore, if you are creating an estate plan for your worldly goods, create an Advance Healthcare Directive for your health.
Talking about your plans and wishes before you are unable to do so – such as due to serious illness or mental decline – will take away much of the stress and the guesswork to try to figure out “what Mom or Dad would want.”
Having the conversation
Try not to go into the conversation feeling awkward. Rather, point out at the start that the discussion should, in fact, settle fears, avoid future conflict, and limit strain on the family.
Based on your own particular family dynamics, you may choose to talk to the kids separately or together. However, speaking to them all together at least once – perhaps at the onset – will allow you to give them the big overall picture of your plans.
At this group meeting, discuss whom you have chosen to take on various responsibilities and why. You will need, at the very least, an executor of your will and someone who will hold medical power of attorney to make medical decisions based upon your wishes, as defined in your Advance Healthcare Directive, also known as a “living will.”
While you will want to discuss the division of your assets during this meeting, your healthcare directive will probably need a good deal more explaining. In your directive, you will have defined what life-sustaining care you want, what procedures you want and don’t want, and your moral, religious, and ethical considerations to guide your medical power of attorney on any specific matters that are not clearly defined in your advance directive.
This discussion will undoubtedly generate a lot of emotion. Answer questions honestly. Explain your reasoning and the research you have done. Be willing to hear their ideas and suggestions, and be willing to make minor adjustments, if you think they have good points. However, if you have taken the time to research and consider your healthcare directives, you probably should not change them too extensively. These are your express wishes, after all.
Finally, offer to talk to each person individually. They may feel more comfortable speaking to you one-on-one about these serious and emotional decisions. Just keep in mind that planning ahead will benefit your loved ones in the long run.
If you have not yet completed your Advance Directive, BCHIP provides an Advance Healthcare Directive form to help you think ahead about what care you would like to receive and what decisions you would like made on your behalf.
What Should Be Included in Your Advance Care Planning?
What is advance care planning and how can you complete it? Our team here in Bucks County is here to help you, your friends, and your loved ones put together these important documents so your wishes are clearly understood and legally stated should something happen to you.
Medical science has improved dramatically in recent years, to the point that we are able to save the lives of people who would surely have died only a few short decades ago. This has been a great blessing for many, but it has also led to situations in which unresponsive individuals who have no reasonable hope of recovery are kept alive for extended periods of time.
Often, at the end of our lives, we are unable to speak for ourselves to define what level of care we would like to receive. For this reason, BCHIP provides an Advance Healthcare Directive form to help people think ahead about what care they would like to receive and what decisions they would like made on their behalf, should they become incapacitated and unable to make these decisions for themselves.
The sections of the Advance Healthcare Directive that you will have to consider include:
- Whether or not you will want life-sustaining medical care, what kind, and under what situations
- Whether or not you want to donate your organs or tissues, if you are a candidate
- What you consider your acceptable quality of life
- What comfort care you would like provided
- Any other instructions you would like followed, regarding moral, religious, or ethical considerations
These issues are not easily or quickly answered. They require some thorough research on your part to understand the terms and what procedures are covered under each. You should then take time to deeply reflect on what would be the best decision for you and your family based on your ethics and beliefs. No one should push you to decide in any particular way, but make sure you are fully informed.
What does “life-sustaining” mean?
Life-sustaining treatment refers to treatment that sustains life and that without which, based on reasonable medical judgment, the patient would die. Since this definition is very broad, it can span many treatments that are considered standard care, such as insulin or dialysis. So you may want to make sure that such a broad definition is not used in your case. Many people live very full lives with life-sustaining procedures or treatments.
However, there are some treatments or interventions for a patient for whom death is fairly imminent—for instance, using mechanical means to sustain the heartbeat or breathing of a patient who no longer shows brainwaves. If this is your definition of life-sustaining and you do not want this type of intervention, you should clearly define this in your Advance Healthcare Directive.
Who will administer your wishes?
Once you have thought through these issues and have made some choices about your future healthcare, you will need to decide who will speak for you when you cannot speak for yourself and ensure that your wishes are followed.
Choose someone who shares your values about matters of life and death. You will want to choose more than one person since you will need an alternate agent in case your primary agent is unavailable. In fact, BCHIP recommends two alternate persons, if possible.
Many patients choose a spouse as the primary person and children or other close relatives as alternates. However, a close friend is also an excellent choice if you have shared values. Have a sincere conversation with these people, and explain your decisions and the research you did in order to inform yourself. Be open to their suggestions, as they may have additional information to help you in your decision process, but maintain your moral and ethical position, even if you see benefits in adjusting some of your original thoughts based on their input. These people love you and want the best for you.
Once you have completed your Advance Directive, make copies for each of your health care agents, keep a copy in your own home in a place that is easy to find (and tell your family where it is), provide one to your lawyer if you have one, and request that your primary physician make your Advance Directive a part of your permanent medical record.
You can update or adjust your Advance Directive at any time. Just make sure you provide updated copies to these individuals. It is wise to keep the older version with the newer one in your home, with the older version clearly marked VOID and the date of the newer version written on it
By taking these steps, you will be able to ensure that your healthcare preferences will be followed, should you be unable to speak for yourself.
