Begin the conversation of making medical decisions

By Mike Heinrich/Guest Column

What would you do if you needed someone to speak on your behalf due an injury or illness? Have you made arrangements with someone close to you, who knows your beliefs, what matters to you and what medical decisions you would want? Have you had in-depth conversations with your loved ones and your physician?

Talking about what we would want if we couldn’t speak for ourselves is not something that most of us would like to do. Most people understand that a terminal illness or chronic condition could lead to our being unable to make decisions at the end of life and that it’s important to select someone be able to speak for us.

However, a sudden, unexpected accident (falling down the stairs or off a ladder, car or bicycle crash, tripping on a curb) or medical incident (heart attack, stroke) could force our loved ones into making decisions for us much sooner than we ever imagined. Would they know what you want them to say?

These considerations are important for all of us individually and for the health care community. As individuals, we all know someone who has suddenly been responsible for making critical medical decisions for a loved one; we may have been that person ourselves. As members of the health care community, we know of situations where loved ones have been suddenly asked to make very difficult decisions. They may not know what to do, or understand the options presented to them. Or there may be disagreements within the family.

When conversations have already taken place, an Advance Directive is available, and someone has been designated to speak on behalf of the patient, it helps not only the patient and their loved ones, but also their medical providers.

Medicare recognizes the importance of these conversations, and began reimbursing physicians for having these conversations with patients.

Honoring Your Wishes, a Johnson County collaborative initiative which began in 2011, encourages everyone age 18 and over to have conversations about future health care decisions and designate someone to speak on their behalf if they cannot communicate. It also encourages people to document their decisions in a legal health care directive and make their wishes a part of the medical record.

Annual audits show that 39 percent of medical records include an Advance Directive, a 15 percent increase in just the last year. Honoring Your Wishes has received national recognition from the John A. Hartford Foundation for improving health care.

Honoring Your Wishes is under the leadership of Iowa City Hospice, a community-based, not-for-profit agency that cares for patients and families in seven counties. Members of the initiative include hospitals, nursing homes, assisted living communities, businesses, faith communities, the Senior Center and others, all working together to encourage that these conversations take place. Mercy Iowa City promotes the Honoring Your Wishes process of having advance health care planning conversations with all of our patients.

Honoring Your Wishes offers advance care planning services by certified facilitators. Appointments for these free consultations can be made at Mercy Iowa City, Iowa City Hospice, the Iowa City/Johnson County Senior Center and the University of Iowa Hospitals and Clinics. Many faith and community health leaders have also been trained to offer these services within their respective settings.

The point, ultimately, is that this collaborative effort led by Iowa City Hospice with many partners can help individuals, loved ones and health care providers to follow patients’ wishes so that they may receive the care they want at the right time.

These are not easy conversations, but they are important. I have started them with my family. More information can be found at

Mike Heinrich is interim president, CEO, executive vice president and CFO of Mercy Iowa City.