October 2010 // Volume 48 // Number 5 // Ideas at Work // 5IAW3
Advance Directives in Extension Services
Few Extension services have incorporated family planning as an offering to clients. This is particularly true as it relates to advance directives, which are generally viewed as highly sensitive. The Southwest Center for Rural Initiatives (Southwest Center), a satellite entity of the Southern University Agricultural Research and Extension Center, started a program where clientele are offered free, private consultations to gain knowledge on advance directives. This serves as an example of the diversity in programs designed to meet the needs of the community, as well as to improve the quality of life for citizens within the Southwest Center's region.
Incorporating Advance Directives into Extension Services
Little evidence could be found to support the incorporation of family planning in Extension services. In 1995, Gregerson and Schmall (1995) discussed a "one stop shop" where the Benton County office of the Oregon State University (OSU) Extension Service hosted a conference that specifically targeted an aging population. The participants received information on topics ranging from dealing with dementia to advance directives. These types of family services, particularly advance directives, offer Extension clientele education that assists in making informed choices.
Although such an effort on the part of OSU's Extension Service appeared to be a model for future offerings in Extension, an extensive review of the literature revealed little evidence to support the incorporation of advance directives or similar end-of-life education programs on the part of other Extension services. Recently, eXtension (2009) began publishing facts about advance directive on the Web, which may provide some indication of the interest in end-of-life education among Extension workers and/or Extension clientele. The Southwest Center for Rural Initiatives (Southwest Center) has begun offering consultations on the pros and cons of advance directives.
The Southwest Center, a satellite entity of the Southern University Agricultural Research and Extension Center, offers diversity in services to its clientele. A comprehensive program on advance directives was incorporated in the community health initiative of the Southwest Center. Citizens within the 10-parish region serviced by the Southwest Center are afforded opportunities to receive free, professional, and knowledgeable advice on advance directives. Private consultations are offered to individuals and family members with the hope of presenting a most comfortable and conducive environment for discussing such a sensitive topic.
The consultations are just one of many Cooperative Extension programs that the Southwest Center and the Southern University Agricultural Research and Extension Center are providing to improve quality of life for the clientele. As with OSU's Extension Services, innovative and practical programs are critically important to meeting the needs of the community. End-of-life education not only broadens the scope of Extension services, it simultaneously helps to yield an informed clientele. This is particularly true in rural communities where cultural lag greatly affects when and how citizens receive information. Unlike other industries/organizations, work in Extension can serve to buffer such a lag, given the inroads and invaluable relationships that already exist.
What Are Advance Directives?
Oftentimes advance directives are associated with family planning. This is both true and false. An advance directive is one of many aspects of family planning. Other aspects might include the development of a last will and testament or even estate planning. In either case, one of the major purposes of doing family planning is an attempt to eliminate uncertainties for the individual and his or her family at the time of incapacitation or death.
Under the Patient Self Determination Act of 1991, advance directives are defined as "written instruction, such as a living will or durable power of attorney for health care, recognized under state law (whether statutory or as recognized by the courts of the State), relating to the provision of health care when the individual is incapacitated." The American Hospital Association (AHA, 2005) defines advance directives as "documents written in advance of serious illness that state your choices for health care or names someone to make those choices, if you become unable to make decisions." The AHA further states that through the use of advance directives, individuals make legally valid decisions about their future medical treatment; however, laws regarding their legality differ from state to state following the basic regulations outlined within the federal law.
Know the State's Law Related to Advance Directives
It is vitally important to become familiar with the law related to advance directives because each state may be different. For example, some states recognize only living wills, while other states incorporate living wills and durable powers of attorney as part of the advance directive. Louisiana recognizes both Living Wills and Healthcare Proxies (or Durable Powers of Attorney). Both documents are covered during the Southwest Center's private consultation. Clients also receive a complimentary copy of Five Wishes, a booklet published by Aging with Dignity that outlines the information necessary to complete one or both of the documents.
An important characteristic of the advance directive consultation offered by the Southwest Center is that it does not exclude any adult (18 years of age or older) who has the mental capacity to discuss and/or complete an advance directive. Clients leave the office with the booklet that they can continue to review independently or with family. The main purposes of the consultation are to introduce individuals to advance directives and to answer related questions. Most important, the consultations provide continued and necessary education for clients to make informed choices.
American Hospital Association (2005). Putting it in writing. Retrieved July 7, 2009, from: http://www.putitinwriting.org/putitinwriting_app/index.jsp
eXtension. (2009, April 05). Communicate your advance directives for health care. Retrieved from October 15, 2009 from: http://www.extension.org/pages/Communicate_Your_Advance_Directives_for_Health_Care
Gregerson, D., & Schmall, V., (1995). One stop shopping education. Journal of Extension [On-line], 33(2) Article 2IAW3. Available at: http://www.joe.org/joe/1995april/iw3.php
Patient Self-Determination Act of 1990, 42 U.S.C. §§ 1395cc(f)(1), 1396a(w)(1) (1991).