Advance-Care Planning
Advance-care planning
It’s important to decide what types of care you want to receive in times of emergency or when facing end-of-life situations. You should consider your options while you have time to think through them clearly, and then discuss your preferences with your family and those close to you.
Put a plan in place for when you may not be able to determine your own medical treatment.
Advance-care planning is the process of discussing, determining, and executing treatment directives—such as a living will—and appointing someone to make health-care decisions on your behalf (a health-care proxy), if you are unable to do so. Advance-care planning can make a critical difference for you, and those who care about you, in emergency or end-of-life care situations.
To be most effective, advance-care planning needs to be a comprehensive, ongoing process that includes your family and friends, your proxy, and your providers. Planning should also reflect your personal values and beliefs, and be adaptable if circumstances change. Consider the following when you plan.
- Communication: Communication is the single most important first step in advance-care planning. It is critical to consider what you want while you have time to think through the options clearly, and then to discuss your options and preferences with your family and others. While advance-care planning may be difficult and emotionally charged, communicating your wishes ahead of time decreases the chance of future conflict and takes the burden off your family.
- Values and beliefs: Personal concerns, values, spiritual beliefs, or views about what makes life worth living are important issues to consider when developing an advance-care plan.
- Preferences: Most people have ideas about how they wish to face death and/or disability, but may be uncomfortable discussing them. Sometimes sharing your own ideas, or reviewing the situations of other family or friends who have been in similar situations can help.
- Health-care proxy: Decide who you will appoint as your health-care proxy (surrogate or agent) decision-maker. Appointing a proxy is a very important decision. The person you choose as your proxy needs to be able to make decisions based on understanding and respecting your values and beliefs about care. Select someone who you believe will understand and be able to carry out your wishes, even if they include denying life-sustaining treatments.
- Help with planning: Many different kinds of professionals can assist you in creating advance directives that help ensure that your wishes will be respected. Lawyers, social workers, and members of the clergy are some examples. Some counselors and social workers—especially those who work for hospice services—are uniquely qualified to offer guidance at all stages of the advance-care planning process.
Develop the necessary legal documents.
Generally, there are two types of legal documents you will need to include in your advance-care plan. A “medical power of attorney” and a “living will.” These two documents, in combination, are called an “advance directive.” In addition, you should consider whether or not you want to include a “Do Not Resuscitate (DNR)” order in your plan.
- Living wills: Sometimes called medical directives, living wills are written instructions for care in the event that you are not able to make medical decisions for yourself. Currently, 47 states and the District of Columbia have laws authorizing living wills. State law, however, can vary on signing requirements and other aspects of a living will, so it is important to check on your state’s requirements when completing a living will.
- Medical power of attorney: Sometimes called a health care or durable power of attorney, a medical power of attorney is a document that appoints a particular person as a health-care proxy or health-care agent to make health-care decisions for you if you are unable to do so yourself (not just during a terminal illness). A health-care proxy is your substitute decision-maker. All 50 states and the District of Columbia have laws recognizing health care powers of attorney. Some specify the types of decisions that health-care proxies can make.
- Do not resuscitate (DNR): This is a physician’s order that is written in a person’s medical record indicating that health-care providers should not attempt life-saving measures such as cardiopulmonary resuscitation (CPR) in the event of a heart attack or respiratory arrest. A request for a DNR can be included in your planning documents or communicated directly to your physician. Also, most health-care facilities have a DNR order policy and forms that a hospital professional can help you with if you choose this option after being admitted to a hospital.
Ensure that your advance-care plan will be carried out.
- Complete a living will and a medical power of attorney. If possible, you should consult with a lawyer or other professional regarding specific state laws or regulations related to these planning documents.
- Make sure your family and other important people in your life understand what your wishes are and what is included in these documents. It is particularly important to discuss your decisions with the individual who will be your health-care proxy to be sure he/she is comfortable with that role, and can be available to carry out your wishes.
- Keep your planning documents easily accessible and in multiple places. Consider carrying a wallet card with you. Give copies to family members, friends, your physician, and/or your lawyer if appropriate. It is critical that your health-care proxy has a copy, or can access a copy quickly, if there is an unexpected emergency.
- Review your plans periodically to be sure that you are still satisfied with your decisions, and your health-care proxy is still able and willing to be responsible for carrying out your plans.
