In times of medical crisis, particularly during emergencies or towards the end of life, critical decisions regarding your healthcare may need to be made. If you are unable to communicate your wishes, having a plan in place ensures your preferences are respected. While you might assume your loved ones know your desires, studies show that they often misinterpret end-of-life decisions almost one-third of the time.
Research indicates that proactive conversations and a well-defined plan significantly increase the likelihood of receiving the care you want. This preparation can also ease the burden of grief for your loved ones, reducing feelings of guilt, depression, and responsibility.
Understanding Advance Care Planning
Advance care planning involves discussing and preparing for potential future medical decisions, especially in situations where you become seriously ill or are unable to communicate your wishes. The cornerstone of this process is engaging in meaningful conversations with your loved ones. Many individuals also choose to formalize their preferences in writing through legal documents known as advance directives.
Delving into What is an Advance Directive for Healthcare
What is an advance directive for healthcare? Advance directives are legal documents that outline your instructions for medical care. These documents only become effective if you are unable to communicate your wishes directly. They ensure your healthcare preferences are known and followed, even when you cannot express them yourself.
The two primary types of advance directives are the living will and the durable power of attorney for healthcare.
Consider your advance directives as dynamic documents. Review them at least annually and update them following significant life events, such as retirement, relocation to another state, or substantial changes in your health status.
Who Should Have an Advance Care Plan?
Advance care planning is not exclusive to the elderly or those with existing illnesses. A medical crisis can strike anyone at any age, potentially leaving you unable to make your own healthcare decisions. Planning proactively helps guarantee you receive the medical care you desire and ensures a trusted individual is authorized to make decisions on your behalf.
The Consequences of Not Having an Advance Directive
If you lack an advance directive and are unable to make your own medical decisions, state laws dictate who can make those decisions for you. Typically, this responsibility falls to your spouse, parents (if available), or adult children. If you are unmarried and haven’t designated your partner as your healthcare proxy, they may be excluded from the decision-making process. In the absence of family members, some states permit a close friend familiar with your values to assist. Alternatively, a physician may be assigned to represent your best interests. Consult your state legal aid office or bar association to understand the specific laws in your state.
Can an Advance Directive Guarantee Your Wishes?
While advance directives are legally recognized, they are not legally binding in every situation. While your healthcare provider and proxy will strive to honor your directives, certain circumstances might prevent them from adhering to your wishes precisely. For instance, a complex medical situation may arise where your preferred course of action is unclear. This underscores the importance of comprehensive conversations about your preferences. Discussing your wishes with loved ones beforehand equips them to navigate unforeseen challenges effectively.
A healthcare provider may refuse to comply with your advance directive if the decision conflicts with:
- The healthcare provider’s personal beliefs.
- The healthcare institution’s policies.
- Accepted healthcare standards.
In such instances, the healthcare provider must immediately inform your healthcare proxy and consider transferring your care to another provider.
Exploring Other Advance Care Planning Forms and Orders
Consider preparing documents to articulate your wishes regarding specific medical issues or matters not covered in your advance directives, such as emergency situations. Discuss the following orders with your doctor:
-
Do Not Resuscitate (DNR) Order: A DNR order becomes part of your medical chart, instructing medical staff in a hospital or nursing facility to forgo CPR or other life-support measures if your heartbeat and breathing cease. It may also be referred to as a Do Not Attempt Resuscitation (DNAR) order or an Allow Natural Death (AND) order. Even if a living will expresses your desire to avoid CPR, a DNR order in your medical file is beneficial if you are hospitalized. Displaying a DNR order near your hospital bed can prevent confusion during emergencies. Without a DNR order, medical staff will make every effort to restore your breathing and heart rhythm.
-
Do Not Intubate (DNI) Order: Similar to a DNR, a DNI order informs medical staff in a hospital or nursing facility that you do not wish to be placed on a ventilator.
-
Do Not Hospitalize (DNH) Order: A DNH order indicates to long-term care providers, such as nursing home staff, that you prefer not to be transferred to a hospital for end-of-life treatment.
-
Out-of-Hospital DNR Order: An out-of-hospital DNR order alerts emergency medical personnel to your preferences regarding measures to restore your heartbeat or breathing outside of a hospital setting.
-
Physician Orders for Life-Sustaining Treatment (POLST) and Medical Orders for Life-Sustaining Treatment (MOLST) Forms: These forms provide healthcare professionals with immediate guidance on your medical care during emergencies. They serve as medical orders in addition to your advance directive. Typically, POLST or MOLST forms are created when you are nearing the end of life or are critically ill, ensuring your specific decisions are understood and honored. These forms may also be called portable medical orders or physician orders for scope of treatment (POST). Check with your state department of health to determine their availability in your region.
Consider documenting your wishes regarding organ and tissue donation and brain donation. Understanding care options such as palliative care and hospice care can also aid in your advance care planning.
How to Begin Advance Care Planning
Consider the following steps to initiate your advance care planning:
-
Reflect on Your Values and Wishes: Consider what matters most to you at the end of life to guide decisions about future care and medical treatment.
-
Discuss Advance Directives with Your Doctor: Medicare covers advance care planning as part of your annual wellness visit. If you have private health insurance, check with your provider. A healthcare provider can offer insight into your current health and potential future decisions. For example, inquire about decisions you might face if high blood pressure leads to a stroke.
-
Choose a Trusted Healthcare Proxy: Select a family member, loved one, or lawyer whom you trust to make medical decisions for you. Discuss your values and preferences with them. If you’re not ready for specific treatments or decisions, begin with general preferences. Share your wishes through letters or videos.
-
Complete Advance Directive Forms: Formalize your care and treatment decisions by completing a living will. Officially appoint your chosen healthcare proxy by completing a durable power of attorney for healthcare.
-
Share Your Forms: Distribute copies of your completed advance directives to your healthcare proxy, doctors, and loved ones. Store copies in a secure location. Some states offer registries for quick access by healthcare providers and proxies.
-
Maintain the Conversation: Regularly discuss your wishes and update your forms annually or after major life changes. If you update your forms, retain previous versions and note the replacement date. If using a registry, ensure the latest version is on record.
Remember that advance care planning is a personal journey. Be flexible and approach it step by step. Start with small conversations about what you appreciate most in life. Your values, preferences, and chosen representatives may evolve. The most important thing is to initiate the conversation.
Finding Advance Directive Forms
You can establish your advance directives at little to no cost. Many states provide free, accessible forms. Here’s how to find them:
If you spend significant time in multiple states, consider preparing advance directives for each state and keeping copies in each location.
-
State Government Websites: Search online for “[your state] advance directive form.”
-
Hospitals and Healthcare Providers: Many hospitals and healthcare providers offer advance directive forms and assistance.
-
Area Agencies on Aging: Contact your local Area Agency on Aging for resources and forms.
-
Legal Aid Offices: State legal aid offices and bar associations often provide free or low-cost assistance.
-
Do You Need a Lawyer for Advance Directives?
A lawyer is not essential, but they can provide assistance. If you have a lawyer, provide them with a copy of your advance directive. For planning assistance, contact your local Area Agency on Aging, state legal aid offices, bar associations, or nonprofit agencies.
Numerous organizations offer online form creation, download, and printing, but may charge fees. Before paying, remember that free options exist. Free online resources include:
If using forms from a website, ensure they are legally recognized in your state and that the website is secure, protecting your personal information. Review the website’s privacy policy and confirm that the link begins with “https” and displays a lock icon.
Consider carrying a card in your wallet indicating you have an advance directive and its location, such as this example from the American Hospital Association (PDF, 40KB).
Further Resources and Information
For additional information about advance directives, consult the following resources:
Administration for Community Living 202-401-4634 https://www.acl.gov
Department of Veterans Affairs 877-222-8387 www.va.gov/geriatrics
OrganDonor.gov Health Resources & Services Administration www.organdonor.gov
American Bar Association 800-285-2221 www.americanbar.org
CaringInfo National Hospice and Palliative Care Organization 800-658-8898 [email protected] www.caringinfo.org
The Conversation Project 866-787-0831 https://theconversationproject.org
National POLST 202-780-8352 [email protected] www.polst.org
PREPARE for Your Care [email protected] https://prepareforyourcare.org
This information is provided by the NIH National Institute on Aging (NIA). NIA experts ensure its accuracy and currency.
