Community First raising awareness about advance health care directive

  • HOLLYN JOHNSON/Tribune-Herald Community First volunteer Kiki Rycraft describes the different parts of an advance health care directive form Wednesday during a Community First presentation at the Aging and Disability Resource Center in Hilo.

The unthinkable happens. Your family’s aging father figure has a heart attack and he doesn’t have an advance health care directive. That means your family must make impromptu medical decisions.

Four months later, Dad’s on a ventilator, unresponsive and it has become clear he’s never going to regain consciousness.


Would he want to stay in the hospital bed, getting nutrients through a tube with a machine breathing for him? Or would he rather his body be allowed to shut down?

Surprisingly, for many, that’s a too-common scenario — when a family member fails to complete an advance health care directive form, say volunteers with Community First, which is working to raise awareness of the need for end-of-life planning for anyone 18 or older.

Volunteers from Community First are offering coaching sessions to help Hawaii Island residents learn how to fill out AHCD forms so loved ones and health providers will have a better idea what patients want.

“Your advance health care directive can now be a part of your overall medical records database,” said Kiki Rycraft, a volunteer who spoke to audience members Wednesday at the Aging and Disability Resource Center in Hilo.

But the directive, which offers directions for your “agent” who can make decisions when you’re unable, should be regularly updated, she said. That’s because a person’s end-of-life wishes often change as they age.

A young person with children might want extraordinary measures taken to stay alive in order to help keiki grow up. But an elderly person whose children are self-sufficient might rather avoid extreme measures. If you had a heart attack and fell to the floor, would you want CPR?

These are the kinds of situations and questions families face when confronted with unexpected life-threatening situations experienced by loved ones, audience members at the ADRC were told.

Advance directives name a specific person as an “agent” to speak on your behalf if you become incapacitated and cannot speak for yourself, Rycraft said.

That agent, a friend or family member you shared your end-of-life wishes with, will use your written and spoken words to guide decisions about your health care.

Without an advance directive, one of your siblings on the mainland might say, “Oh, I talked to Mom and she wants ‘this,’” said Charlene Iboshi, Community First committee chairwoman.

“You say, ‘Mom, did you say this?’ and she will say, ‘No! Well, maybe. It’s hard to remember,’” Iboshi said.

It’s common for family members to have disagreements when there’s no advance directive, said Anthony Kent, community engagement manager for Community First.

With an advance directive, he said, at least everyone in the family knows what you want — and your agent has legal authority to make medical decisions if you’re incapacitated.

If you’re still able to speak, and mentally capable, you retain authority to make decisions, the Community First volunteers said.

The advance directive also indicates whether you want the agent to have immediate say in an emergency, or if you want to require that your primary physician first declare you unable to make or express decisions.


“I think a lot of people are under the impression, ‘My family knows what I want’ — but maybe they don’t,” Kent said.

Email Jeff Hansel at

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