By Patty Dunn, Hospice Program Coordinator

There has been a lot of publicity lately about advance care planning and advance directives. Simply put, advance care planning is a process of thinking about, discussing, and creating a written healthcare plan (advance directive) that tells others what you would want if you couldn’t tell them yourself. Why do you need one? If you had a serious illness or accident and couldn’t communicate, those closest to you — your spouse, your children, as well as your doctor — would have to make healthcare decisions for you. An advance directive helps them know what you would want.

Despite growing awareness of the importance of advance directives, many people are reluctant to engage in these discussions with their loved ones and healthcare providers. The Brattleboro Memorial Hospital (BMH) Ethics Committee wants to help change that. Why? Because we are aware that too many people are dying in places, and in ways, they don’t want—often because their “wants” aren’t known. The personal, familial, and community costs of not talking about and preparing for our deaths are too high to fully calculate. How do you put a price on the suffering that comes from futile healthcare treatments, the toll of stress and family discordance, and the subsequent sense of helplessness and regret that can result?

This hit home for me in a personal way when, at age 69, my Mom suddenly and unexpectedly lost her memory, her ability to communicate, and her mental capacity. She was found to have two large metastatic cancerous tumors in her brain for which there was no curative treatment. As our family agonized about how to advocate for her, in particular, whether to decide to subject her to brain surgery, we wondered what she would say and do if she could tell us. She did not have an advance directive (living will) that could guide us, nor had we ever talked about these things. Unfortunately, as is often the case when one’s wishes aren’t clearly known, our family was split about what to do and how to proceed. Those of us who didn’t want to put her through potentially debilitating brain surgery to extend her life a little and with questionable quality, were outnumbered by those who wanted her alive longer at all cost. It was a heart wrenching experience which I continue to process 12 years later, and not without some unresolved guilt and regret. This haunting experience fuels my passion for thinking and talking ahead of time about death, what’s important to me, and what plans need to be made now to reflect my wishes when that time inevitably comes. It’s hard to describe the paradoxical peace of mind that comes with planning ahead, especially when you’re aware of what’s possible when you don’t.

Taking Steps Brattleboro is a new, community-wide initiative designed to encourage people to engage in advance care planning discussions and to help them complete their advance directive forms. Co-sponsored by BMH and Brattleboro Area Hospice, Taking Steps Brattleboro has a group of trained advance care planning volunteer facilitators to help you understand the process, map out your individual steps, and get this vital task completed. It is available to anyone in the community free of charge. Advance care planning is a way we care for one another. To receive this assistance, call Taking Steps Brattleboro at 802-257-0775, ext. 101 or 802-460-1142, ext. 101.

This series is written by the Brattleboro Memorial Hospital Clinical Ethics Committee. Should you have questions or suggestions for these monthly articles, please contact: Martina Sczesny, MD – Chair, Clinical Ethics Committee, at

The BMH Clinical Ethics Committee provides assistance to those persons directly involved in a patient’s care, to identify, analyze, and resolve ethical problems pertaining to the care of the patient. This may include the patient, their family, and medical and hospital personnel.