FARGO — Deb Pender always thought that having an advance directive, also known as a living will, was a good idea, but she had never gotten around to it.

That is until this past January, when Pender, 62, went for her annual physical. The folks at Sanford Health reminded her about the option, and she decided it was time to do it.

Advance health care directives spell out how a person would want to be cared for if they could not communicate their wishes themselves. Health care providers advise that such directives are essential for all adults and that during the current pandemic it makes even more sense, particularly for those at risk of complications from COVID-19.

After deciding an advance directive was something she wanted, Pender said her next step was talking it over with her daughter, Jenna, who is 27.

Such conversations can be difficult for some, but Pender said her talk with her daughter went great, as did her conversation with a facilitator at Sanford, who guided her in the process.

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"It was very helpful to talk through the whole idea of end-of-life decisions," said Pender, who added that because of her faith she's not concerned about what may come after this life.

"I'm not worried for myself how that would go. But, I was concerned for my family and especially my daughter," said Pender, who's semi-retired from Moorhead Area Public Schools, where she's worked for 25 years.

Her daughter, she said, was happy to be given a potential role in future decision-making regarding her care.

"It's more than just: Are you going to stay on life support or not? There's other pieces to it," said Pender, whose daughter lives out of the area and has not been able to visit during the pandemic.

When they are able to get together, Pender said a review of her advance directive will be among the first things they do.

Brave conversations

Dr. Rich Vetter, chief medical officer at Essentia Health, said it's likely people at high risk for medical complications are feeling vulnerable during the current COVID-19 pandemic.

He said with that in mind, Essentia is in the process of identifying patients at high risk for COVID-19 infection with the aim of talking with them about advance directives and making sure whatever care choices they make match up with their individual needs and wants.

Vetter said an important aspect of such planning is the selection of a person who can act on a patient's behalf if they can't make decisions for themselves.

Once that person is found, it's essential they have a clear understanding of the patient's wishes, Vetter said.

Having such conversations prior to an end-of-life situation can reduce family conflicts, though not always, according to Vetter.

Still, he said that in his nearly three decades of practice, he sometimes has family members of patients who set up advance directives come back to him "just really thankful we took the time with their loved one to have that conversation."

He said families shouldn't be afraid to talk about end-of-life questions.

"Once they have this conversation, it actually can bring a sense of peace to them, knowing they have a plan in place," he said.

Gail Christopher, an RN with Sanford Health's Advance Care Planning Program, said she typically works with patients who have been referred by their doctors.

However, because of the pandemic fewer people are visiting their doctors and most don't feel comfortable right now having a face-to-face meeting with an advance care planning facilitator, Christopher said.

'Missed opportunity'

Instead, she said, information packets are being sent to patients and follow-up conversations are done over the phone.

Though much can be accomplished by phone, Christopher said advance directives ultimately require the signature of a notary, or the signatures of two witnesses.

She said it's important that patients have a clear understanding of what an advance directive is all about.

"It's much more than what would you want, or what would you not want," she said. "It's about who would you want to speak for you?"

Pender agreed, adding that when it comes to advance directives the most important step is the first one.

"We need to take those steps and take those risks and especially right now," she said, recalling a time when her grandmother, whom she was close to, asked to have a talk with her about end-of-life wishes.

Pender said she declined the invitation.

"It was too hard and I wasn't ready to do that," she said. "Now, I think: 'What a missed opportunity that was.'''

An earlier version of this story incorrectly identified the local health care provider that gave Deb Pender guidance on her advance directive. It was Sanford Health.