As people age, it’s important to have conversations with loved ones about health care decisions that may need to be made down the road. No one likes to dwell on the possibility of being cognitively impaired, but it’s crucial to engage in advance care planning while everyone is healthy and able to discuss aspects openly.
In making decisions about our healthcare, it’s vital to have a plan in place in case we’re ever unable to speak for ourselves. That’s where advance-care planning comes in.
What is Advance Care Planning?
Advance care planning is the process of thinking about and documenting our healthcare wishes in advance of a time when we may no longer be able to communicate them. This can be especially important for people with chronic or terminal illnesses, but it’s something everyone should consider regardless of age or health status. It can include things like choosing a healthcare proxy (also called a healthcare agent or power of attorney for healthcare), drafting a living will and deciding on end-of-life care preferences.
It’s important to have these conversations early and often, as people’s wishes can change over time. Additionally, it’s important to choose a healthcare proxy who is comfortable having these conversations and willing to make tough decisions if necessary. The proxy should also be someone who knows the patient well and is familiar with their values and beliefs.
Different Types of Advance Directives
There are several different aspects of advance care planning, so it’s important to take some time to familiarize yourself with the different options before taking action.
An advance directive is a legal document that spells out your wishes for medical care in the event that you’re unable to communicate them yourself. Here are some things you should keep in mind when assembling an advance directive:
Living will: A living will is a document that outlines a person’s wishes for end-of-life care in the event that they are unable to communicate those wishes themselves. It can include things like whether or not you want life-sustaining treatment (e.g., artificial ventilation or feeding tube) and your preferences for pain management.
Durable power of attorney for healthcare: This document appoints someone (called a healthcare agent) to make medical decisions on your behalf if you are unable to do so yourself. You should choose someone you trust implicitly and who knows your values and preferences well.
Do not resuscitate (DNR) order: A DNR order is a medical order that instructs first responders not to perform CPR if you stop breathing or your heart stops beating. It should only be used if you have a terminal illness or condition and you have specifically requested this type of order.
Do not intubate (DNI) order: A DNI order is a medical order that instructs first responders not to insert a breathing tube if you stop breathing or your heart stops beating. It should only be used if you have a terminal illness or condition and you have specifically requested this type of order.
Out-of-hospital DNR order: An out-of-hospital DNR order is a document that allows you to specify your DNR preferences in advance so that first responders know not to resuscitate you if they find you outside of a hospital setting (e.g., at home or in a nursing home). This type of order is only effective in certain states, so be sure to check the laws in your state before getting one.
Physician orders for life-sustaining treatment (POLST) form: A POLST form is a document that outlines your end-of-life care preferences and must be signed by both you and your doctor. It provides specific instructions for medical providers on how to treat you if you are unable to communicate your wishes yourself. Not all states have POLST forms, but they are available in some states as an alternative to traditional advance directives like living wills.
Medical orders for life-sustaining treatment (MOLST) forms: MOLST forms are similar to POLST forms, but they must be signed by both you and your doctor AND they are binding in all 50 states. So if you move to another state, your MOLST form will still be valid and your doctors will be required to follow the instructions on it.
Additionally, brain tissue and organ donation are important considerations for many people.
National Healthcare Decisions Day
It can seem overwhelming trying to think about all of these things in advance, but starting the conversation with your loved ones is a crucial first step. National Healthcare Decisions Day (NHDD) — April 16 — exists to inspire, educate and empower the public about the importance of advance care planning. NHDD is an initiative to encourage patients to express their wishes regarding healthcare and for providers and facilities to respect those wishes, whatever they may be.
A key goal of NHDD is to demystify healthcare decision making and render the topic of advance-care planning inescapable. Among other things, NHDD helps people understand the process includes much more than living wills; it’s an undertaking that should focus first on conversation and choosing an agent.
Do you have a question related to advance-care planning at Cass County Medical Care Facility? Contact us today, where our staff is awaiting to assist!