Talking about advance care planning
Not many people are eager to discuss the health care decisions that they may face in an emergency or in the final years of their life. But, as difficult as these conversations can be, they’re necessary to ensure that your health care wishes are being honored—especially when you’re unable to communicate them or make decisions for yourself.
Although it is a sobering and emotional discussion, advance care planning is an important piece of your health care plan.
“Just like new parents might choose a birth plan or you might choose a specific primary care doctor or surgeon because of their background or bedside manner, it’s important to designate your preferences for health care and end-of-life care and to designate someone who can represent you if needed,” explains Brian Duke, system director of senior services at Main Line Health. "Not only does this help prepare you for the future, but your family, too. Advance care planning helps alleviate the emotional burden loved ones might face in trying to determine and carry out your health care wishes."
Although advance care planning is something that older adults begin to consider as they enter the later stages of life, Duke urges all adults to consider it.
“Making these decisions, or giving others the tools and information to make them on your behalf, is not something that is exclusive to seniors,” he explains. “Emergency situations and medical crises can happen to anyone, and it’s important to be prepared for them.”
Health care decisions to prepare for
While individual needs and decisions may vary depending on your health status, there are some common health care decisions that you may face if you are in critical condition, including those related to:
- The quality of life that you consider worthwhile
- Selecting hospice care or palliative care
- Tube feeding or artificial nutrition and hydration
- Ventilator use
- Using CPR for resuscitation
- Comfort care
Most of us could benefit from learning more about these important decisions and others. An appointment with your primary care doctor can help.
“Advance care planning often involves very difficult, and sometimes uncomfortable, conversations about the care you wish to receive if you became unable to speak for yourself. These crucial conversations can help you make decisions based on your personal values and preferences, and can reduce uncertainty and confusion for your loved ones when these decisions need to be made. It’s beneficial to have these conversations with your physician and other members of your health care team so that you can be informed and confident in your care planning options for the future,” says Karl Ahlswede, MD, medical director of palliative care at Main Line Health.
Once you’ve made those decisions with the help of loved ones and your doctor, you should have them documented.
Documenting and communicating your wishes
As you begin the advance care planning process, there are several ways to document and communicate your decisions with your loved ones and future medical teams who may be caring for you, including:
- A living will: This is a document that tells your doctor or other medical professionals how you want to be treated if you are dying, permanently unconscious or unable to make decisions about treatment.
- A medical power of attorney: Designating a power of attorney involves selecting someone who can make decisions regarding your care if you cannot.
- An advance directive: This is a combination of a living will and medical power of attorney.
- An out-of-hospital DNR (Do not resuscitate) order: In the event that your heart stops beating or is beating unevenly, a DNR instructs your doctor and hospital staff to refrain from trying to restore it to a normal rhythm. Without a DNR, every effort will be made to restore your heart to normal rhythm. This form must be completed in conjunction with your physician.
- POLST (Pennsylvania Orders for Life Sustaining Treatment): a portable set of medical orders for patients who are seriously ill, which is completed based on conversations between patients and their health care provider about their goals of care, diagnosis, treatment options and quality of life. This form is useful for patients that do not want cardiac resuscitation but do still want other aggressive kinds of medical treatment.
- Organ and tissue donation: If you have opted to be an organ donor, it allows your healthy organs and body parts to be donated to those needing a transplant, in the event that you pass away. Some states allow you to designate your organ donation status on your driver’s license, and others require you carry an organ donor card that communicates your wishes.
Once you’ve made a decision about where you stand on these issues and how you’d like your medical care to be delivered, you can fill out forms to document these decisions. You can contact your local agency on aging for copies of the appropriate paperwork. Once this paperwork is completed, be sure to share copies with your power of attorney, family members and loved ones who may need to be aware of your wishes.
Reviewing your advance care plan
The earlier that you begin your advance care planning, the better. But don’t let it be a one-time thought. These discussions need to be reviewed regularly as you age and your health status changes. Main Line Health offers a useful guide that will help you with all the steps in advance care planning.
“These decisions and documents are something you should revisit regularly. It’s important to establish a plan now, but make sure that it’s updated to reflect changes in your life and your health,” says Duke.