The Worry Control Workbook

CHAPTER 8
Controlling Worries About
Health and Safety Issues

cont.

Advanced directives

Some people relieve worry about possible short or long term health emergencies by developing advanced directives that give supporters directions on how they want to be treated and cared for in the event they lose the ability to make these decisions for themselves.

I have had recurring episodes of severe, suicidal depression in the past. When I was well I realized that, by not having an emergency plan for my supporters, I was putting my health and life at risk. Although it was hard to think of the possibility of experiencing such deep despair again, I felt it was in my best interest and in the best interest of my family and friends to develop for them a set of instructions to use as a guide in case I got very depressed again. It has helped control worry for everyone involved.

Following is a sample of an advanced directives:

Advanced Directives

Name _______________________________ Date _____________________

Symptoms or circumstances that indicate to others that they need to take over full responsibility for my care and make decisions in my behalf.

1. I don't know my family members and friends.
2. I can't do the things I normally do to take care of myself and my family.
3. I do not respond to others.
4. I am unable to get out of bed.

If the above symptoms or circumstances come up, I want the following people to take over for me:

• Name Connection/role Phone number
• Amelia Jones sister 739-4637
• Tammy Searles best friend 642-7683
• Edward Frank spouse 739-4273
• Dr. Harriette Shipp physician 682-4932
• Laura Ellis nurse practitioner 682-4932

I do not want the following people involved in any way in my care or treatment:

Name Why you do not want them involved (optional)
Dr. Thomas Jones uncomfortable with his style

If my supporters disagree on what is to be done, I want my spouse to make the final decision.

List the medications you are currently using and why you are taking them.

• Synthroid in the morning for hypothyroidism
• Multivitamin in the morning

List those medications that would be acceptable to you if medications became necessary and why you would choose those.

• Darvon for pain
• Tagamet for ulcers

List those medications that should be avoided and give the reasons.
Steroids have given me severe side effects in the past

List treatments that have helped you in the past and when they should be used.
A massage always helps me feel better.
If my breast cancer recurs, chemotherapy is acceptable.

List treatments you would want to avoid.
I do not want any experimental treatments.

Set up a plan so that you can stay at home or in the community and still get the care you need.
If possible I would like to stay at home and be cared for by family members and friends who take turns providing my care.

List treatment facilities where you prefer to be treated or hospitalized if that becomes necessary.
I would want to go either to Vermont General Hospital or Franklin Health Center

List treatment facilities you want to avoid.
I would want to avoid being a patient at the Country Convalescent Home or the Tamworth Community Hospital.

List those things that others can do for you that would help you feel better.
Others can:
play me popular music from my compact disc collection
give me a back rub
read to me from the poetry books on the shelf by my bed
serve me healthy, wholesome foods with no dairy or sugar
hug me
tell me what is going on

List those things you need others to do for you and who you want to do what.
What I need done Who I'd like to do it

• Pay my bills my son Tom
• Keep the house clean, water
• my plants, buy the groceries my sister Susan
• Take care of the pets my daughter Patti
• Pick up and sort the mail my friend Sue

List those things that others might do, or have done in the past, that would not help or might even make the situation worse. Forcing me to do things Chattering incessantly Playing rock music

I developed this plan on (date) February 2, 1997 with the help of Edward Frank.
Any plan with a more recent date supersedes this one.
Signed ______________________________ Date __________________
Witness _____________________________ Date __________________
Witness _____________________________ Date __________________
Attorney _____________________________ Date __________________

Once you have developed an Advanced Directives, give copies to all the people who would be involved in your care. Keep one copy in your file and let others know where to find it.

You can use the following form to develop your advanced directives. Once you have developed an Advanced Directives, give copies to all the people who would be involved in your care. Keep one copy in your file and let others know where to find it. Update the form as your condition changes. If you have access to a computer, inputting this form can ease the process of making changes.

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