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Planning Ahead: Advance Directives

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Updated August 25, 2008

Planning Ahead: Advance Directives
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Advance directives are a way to make your wishes about end-of-life care known and bring you one step closer to "a good death".

There’s a lot of talk in our society lately about a “good death." A good death may look differently to each individual, taking into account their personal wishes and priorities. I’ve seen a number of “good deaths” working in hospice, deaths where the patient’s and family's wishes are honored, and they are at peace with the decisions they’ve made.

I’ve also seen a number of bad deaths. These deaths are usually ones where the patient is subjected to futile treatments that prolong death, rather than life. Most often, these patients are unable to make their wishes known and their health care decisions are left to scared and unsure family members.

By taking a few simple steps, you can make your wishes known and take the guess work away from your loved ones.

Advance Directives

Advance directives are a way for you to make decisions regarding health care in advance. This document allows people to plan their health care before they become incapacitated, or unable to make sound decisions for themselves.

Advance directives consist of two documents. The first is a living will. This document allows you to make your wishes known about the care you would like to receive at the end of life. It includes your wishes regarding:

  • medical procedures you would want to receive
  • procedures you would like to avoid
  • life support
  • being kept alive versus comfort care only

These aren’t decisions that are always easy to make. For that reason, it’s beneficial to consider them well in advance of a life-limiting illness or injury. Many people become unable to make these types of decisions as they approach the end of life, so it’s a good idea to complete a living will as early as possible.

The second document contained in an advance directive is a health care proxy, also known as a durable power of attorney for health care (DPOA). In this document, you appoint someone to make decisions on your behalf if you should be unable to do so. It’s important to choose someone who you can trust to make decisions that honor your wishes. You may also want to appoint a second DPOA to step in if your first choice is unable to make decisions for you.

Honoring Advance Directives

Because you can’t rely on a piece of paper alone to make your wishes known, it is vital that you speak with your appointed health care proxy, or DPOA, about them in detail. Having this conversation is a step that can’t be skipped. You may have wishes for your care that your DPOA isn’t comfortable honoring based on their own values. Discussing this in detail can avoid distress down the road.

It’s also important to make sure everyone involved in your care has a copy of the advance directive. This may include your physician, hospital, nursing home, and home health or hospice agency. Keep the original in a safe but easily accessible place, and have copies readily available in case of an emergency.

Advance Directives in Your State

Laws regarding advance directives differ by location, so it’s important to obtain the right document. Most health care agencies, social workers, and attorneys have the document readily available to you. You can also download the form for your state and get more information from the National Hospice and Palliative Care Organization’s (NHPCO) website at www.nhpco.org.

Do Not Resuscitate Order

Even though your advance directive may state your wishes regarding life support and medical procedures, most states still require that a do not resuscitate (DNR) order be signed by the patient, or patient’s representative, and physician to withhold CPR. Paramedics and other health care professionals are usually required by law to perform CPR and other measures to try to resuscitate, or revive, a patient whose heart or breathing has stopped unless they are made aware of a valid DNR.

If it is your wish to not be resuscitated, don’t rely on your advanced directives alone to make that known. As with advanced directives, physicians, social workers, health care agencies, and attorneys can provide you with the proper form.

Sources:
Advanced Directives, National Hospice and Palliative Care Organization's Caring Connections

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