Whether you are a senior facing a terminal illness, or a person preparing for the natural end of their life, advance care planning can help make sure your medical care aligns with your values and wishes. In the event where you’re incapacitated or too sick to make your own decisions, advance care planning documents can express to doctors and other healthcare providers what treatment you do or do not want to receive. They can also legally designate a person to make medical decisions on your behalf, whether it be a family member or friend who understands and can communicate your care preferences and beliefs.
Advance care plans can be developed at any time, and should be revised and updated in accordance to a person’s health and life circumstances. For seniors who have a terminal or chronic illness, their advance care plans will likely revolve around their disease’s trajectory and how their medical condition progresses overtime. Creating a comprehensive advance care plan will alleviate the stress that comes with sudden changes to a person’s health, and help outline what medical treatment he or she wishes to receive during the different stages of their disease or illness.
Discussions surrounding end-of-life care are easy to avoid, but having advance care documents will put you in the driver’s seat of your own health. If you or a loved one is in the process of creating an advance care plan, here are some of the important documents you should include:
A living will is a legal document that outlines what end-of-life care a person wishes to receive if they’re unable to make their own decisions. Such procedures can fall under emergency treatments that prioritize extending a person’s life, or palliative care that focuses on improving quality of life. The treatments included in a person’s living will likely vary for each individual, as such decisions are informed by their respective medical condition, values, and care preferences — for example, does the senior want to remain alive as long as possible, no matter the situation or potential complications? Or do they prioritize comfort and pain-relief before they pass away?
Even if you or your loved one is currently healthy, having a living will can prepare you for sudden medical emergencies, and ensure your treatment is consistent with your values. This is especially important if you do not want to receive aggressive treatment for your end-of-life care, as American doctors often default to emergency treatment to keep a patient alive, such as CPR (cardiopulmonary resuscitation), ventilator use, and artificial nutrition and hydration. These treatments can be expensive, and may come with risks that can affect your quality of life. For example, the force required to perform CPR can cause broken ribs or a collapsed lung, or a feeding tube can cause discomfort and lead to increased risk of infection, pneumonia, and nausea. When creating your living will, consider your own end-of-life wishes and what medical interventions you would want to help keep you alive. It can be helpful to consult your doctor about the various medical scenarios and treatments you can encounter.
Some seniors may elect for palliative care as their main end-of-life treatment. Palliative care is typically offered to patients with serious or chronic illnesses, such as cancer or heart failure, and focuses on relieving suffering, alleviating pain, and improving quality of life. Contrary to popular belief, palliative care can be administered concurrently with life-extending treatment, but can transition to hospice care if doctors determine treatment is no longer working.
Durable Power of Attorney for Health Care
A durable power of attorney for health care is a legal document that designates a person to make medical decisions for you when you are unable to do so. While a living will outlines specific treatments that you do or do not want, you may encounter a situation where a procedure not listed on your will is needed. Here, your health care proxy can decide for you whether undergoing the treatment is consistent with your care wishes.
When choosing a health care proxy, it is important that you pick somebody who understands your values and care preferences. Often, this requires having difficult discussions with them about what you want at the end of life, and what treatment you’d like to receive under various medical scenarios. Your health care proxy should be able to access your medical records, have your doctor and other healthcare professional’s contact information, and be trusted to make difficult and sudden medical decisions that best honor your wishes.
DNR (do not resuscitate) Order
In the event that your breathing has stopped or your heart isn’t beating, a DNR order lets your doctor or other healthcare providers know not to perform CPR or use an AED (automated external defibrillator) to restart your heart. Seniors may elect to have a DNR as previous studies have shown that CPR has a low success rate for older adults with terminal illnesses and other serious health problems. In addition, CPR can affect a senior’s quality of life, as it can cause broken ribs, brain and other organ damage, or permanently require them to use a machine to breathe. To decide if having a DNR is right for you, consult your doctor or healthcare provider who is most familiar with your medical condition and symptoms.
Physician Orders for Life-Sustaining Treatment (POLST)
A POLST form is a medical order filled out by your doctor following discussions about your end-of-life care goals. Best used as a supplement to your other advance directives, it can help express what emergency treatments you wish to receive when you’re unable to do so, including whether or not you want to be resuscitated, whether you wish to receive medically assisted nutrition and hydration, or if you prefer palliative care as opposed to more aggressive treatment options. These forms are useful as they allow healthcare professionals to act immediately in the event of a medical emergency, and can travel with you between care facilities, such as hospitals, assisted living communities, and your home.
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