Advance Care Planning

Advance care planning is a process that enables individuals to make plans about their future health care. Advance care plans provide direction to healthcare providers (HCP) when a person is not in a position to make and/or communicate their own healthcare choices. Advance care planning is applicable to adults at all stages of life. Participation in advance care planning has been shown to reduce stress and anxiety for patients and their families, and lead to improvements in end of life care.

To the well-organized mind, death is but the next great adventure. 

J.K. Rowling

Having the Conversation

One of the most productive ways to help patients as they approach the end of life is to encourage them to have a conversation with their loved ones about their preferences for treatment and end-of-life wishes. This conversation should include family members, friends, Health Care Providers, and religious or spiritual leaders—anyone in the patient’s life and involved with their care. In addition to promoting this conversation, you can enable it

Talking to Your Family and Loved Ones

Direct Questions: What’s most important to you as you think about how you want to live at the end of your life? What do you value most? Thinking about this will help you get ready to have the conversation.  Think about who is the most important person to talk with: your partner or spouse, parent, child? Who is the person whom you would like to represent you if you cannot speak for yourself? Think about when is the best time to talk?

Talking to Your Physician

Even if you are young and healthy, it is important to have an advance care planning conversation with your physician. If you are over age 65 and/or you have a serious chronic illness, it is even more important to have this conversation with your physician. It is never too early to provide a “road map” for your physician and your loved ones to let them know what matters most to you and to guide your care. 

Advance Directives

Every adult needs an advance directive for health care (AD).  Ideally, this includes both a Living Will and a Durable Power of Attorney, or Health Proxy. Regardless of age and health status, we never know when some kind of an event might leave us unable to speak for ourselves. A previously written record of a person’s health care wishes is invaluable if that person is not able to make or communicate decisions about his or her desired medical care.

Living Will

This part of the Advance Directive allows you to specify which kinds of treatment and care you desire if you are unable to speak for yourself. A living will allows you to express your wishes about any aspect of your health care, including decisions regarding life-sustaining treatment and procedures that you do or do not want.

Durable Power of Attorney

The second part of the Advance Directive is often referred to as the Durable Power of Attorney for Health Care. It can also be referred to as Health Care Proxy, Agent, Surrogate or Representative. It provides the designation of someone who will be able to make decisions regarding your health care if you are unable to speak for yourself due to illness or incapacitation. Hopefully you will choose a person whom you trust to go to bat for you and express exactly what your wishes are when you are not able.

California’s Advance Directive

You have the right to give instructions about your own health care. You also have the right to name someone else to make health care decisions for you. This form lets you do either or both of these things. It also lets you express your wishes regarding donation of organs and the designation of your primary physician.

Physician Order for Life Sustaining Treatment – POLST

In some states, it is also known as a MOLST (Medical Order for Life-Sustaining Treatment). The POLST is designed to help medical professionals honor the end-of-life wishes of their patients. The form documents physician orders that adhere to the patient’s wishes and treatment goals and are readily accessible to emergency medical personnel, assisted living facility staff and other caregivers. They follow a patient from home, to emergency services, and to a hospital or other facility.

Out-of-hospital DNR

Your Do Not Resusitate order is meant to alert any emergency medical services (EMS) personnel to not attempt resuscitation or perform heroic life-saving measures including CPR, if those are your wishes.  Like the POLST, this document should be discussed with your physician, who also signs the form.  It is usually requested by a person already seriously ill who wishes to avoid unwanted medical interventions according to his or her specific end-of-life health care wishes.

Dementia Provisions

A Living Will for Dementia. Since being featured in the NY Times, it has been downloaded more than 100,000 times, with downloads continuing at a rate of about 2,000 per month. It provides brief descriptions of the stages of dementia. Under each stage it provides options where you can indicate which medical interventions you’d want at that stage. The dementia directive is a communication tool. It provides a way to share your views with loved ones, to let them know what you would want in case they have to make medical decisions on your behalf.  Families often face making difficult decisions about their loved ones’ care. This directive can help them feel more sure that the decisions they are making are closer to what you, their loved one, would have wanted.

Contact a Volunteer

If you have questions, would like to discuss advance care planning further, or need help preparing your advance directives, please contact us.  A volunteer will follow up with you to find out how we can assist.

“Thank you for the workshop and your work in end of life care. I hope this contribution helps the cause.” C.H.

End of life choices California

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