Advanced Care Planning

Advanced care planning is the process of preparing for future healthcare decisions, particularly in the event that you become unable to communicate or make decisions for yourself. Two important tools in this process are living wills and advance directives. Understanding these documents is essential for ensuring your healthcare wishes are respected.

1. What Is Advanced Care Planning?

Advanced care planning involves:

• Considering your healthcare preferences: What kind of treatments or interventions you would want or not want if you are seriously ill or nearing the end of life.
• Discussing your wishes: Sharing your decisions with loved ones and healthcare providers.
• Formalizing those decisions: Putting your wishes in writing through legal documents such as a living will or an advance directive.

2. What Is a Living Will?

A living will is a legal document that outlines your wishes for medical treatment in the event that you are unable to communicate due to illness or incapacity. It specifically addresses situations like terminal illness, permanent unconsciousness, or end-of-life care.

Key Elements of a Living Will:

• Medical treatments: You can specify which treatments you want or do not want, such as:
  • Life support (ventilators, feeding tubes)
  • Resuscitation (CPR or defibrillation)
  • Pain management
  • Dialysis
  • Organ donation
• End-of-life care: You can express preferences for comfort care (hospice or palliative care) if you’re nearing the end of life.
• Revoking a living will: You can update or revoke your living will at any time while you’re still competent.

Benefits:

• Clarifies your wishes: Ensures that your medical care reflects your values and preferences.
• Reduces family burden: Prevents family members from having to make difficult decisions without knowing your wishes.
• Ensures consistency: Makes sure that healthcare providers follow your instructions.

3. What Is an Advance Directive?

An advance directive is a broader legal document that encompasses a living will and may also designate a healthcare proxy or durable power of attorney for healthcare—someone you trust to make medical decisions on your behalf if you are unable to do so.

Types of Advance Directives:

• Living will: As described above, it details your healthcare preferences.
• Healthcare proxy or medical power of attorney: This names someone (a proxy or agent) to make decisions about your care if you’re incapacitated. They act based on your instructions or what they believe is in your best interest.
• Do Not Resuscitate (DNR) order: A DNR is a specific instruction that tells healthcare providers not to perform CPR if your heart stops or if you stop breathing.

Important Considerations:

• Communication with your proxy: Make sure your healthcare proxy knows your values and what matters most to you. It’s essential they are comfortable making these decisions.
• Legal status: Advance directives are legally binding documents, but laws vary by state or country. It’s important to ensure your documents meet local legal requirements.

4. The Importance of Both Documents

• Living will: Focuses on documenting your treatment preferences.
• Advance directive: Includes your living will but goes further by designating someone to make decisions for you when you cannot.

Together, these documents ensure that your healthcare wishes are known and followed, especially in critical situations where you cannot express them yourself.

5. How to Create a Living Will or Advance Directive

• Talk to your doctor: They can explain medical procedures and help you understand the potential outcomes of various treatments.
• Speak with an attorney: While you can often complete these documents on your own, it’s a good idea to have a lawyer ensure everything is legally sound.
• Inform your loved ones: Make sure your family knows where to find these documents and understands your wishes.
• Store the documents properly: Keep the original documents in a safe place, and provide copies to your healthcare proxy, doctor, and close family members.

6. When to Update These Documents

• Change in health: After a new diagnosis or major health change.
• Change in wishes: If your healthcare preferences change over time.
• Loss of a proxy: If your designated healthcare proxy is no longer available or able to serve in that role.

Example Scenarios:

• Without a living will: If you are in a coma without a living will, your family and doctors may not know your preferences for life support or aggressive treatment, leading to conflict or decisions that don’t align with your values.
• With an advance directive: If you develop a serious illness and can no longer make decisions, your healthcare proxy can speak for you, ensuring that the treatments you receive match what you wanted.