End of Life Planning Part One
The purpose of advance care planning is to ensure that you can get the medical care that is consistent with your goals and values. This is something that can be done for adults of any health status. In fact, it is something that’s important for every adult so that it’s available in emergencies. However, many people don’t have any form of advance directive filled out. A metaanalysis from 2017, which reviewed 150 studies that were made up of a total of 795, 909 individuals, showed that only 36.7% of the people involved in the studies had completed an advance directive (29.3% of those were living wills); this study showed similar numbers for each year reviewed, from 2011 to 2016 (Yadav et al., 2017).
As much as we may not want to think about our death and what treatments we do or don’t want in certain situations, it’s an important thing to do. Unfortunately, medical crises can occur at any time and these documents not only allow everyone to make their preferences known, but it also saves loved ones from having to make difficult decisions. These decisions can be so difficult that sometimes medical ethicists become involved; Bud Hammes, a medical ethicist, had many of conversations with families who had to make decisions for loved ones and states that “The moral distress that these families were suffering was palpable," he says. "You could feel it in the room." (Joffee-Walt, 2014). Having your wishes, whatever they are, set out allows your loved ones to act on them instead of trying to decide what you would have wanted- and that takes a huge burden off of them.
So where do you even start with all of this? First, we have to clear up the jargon being used.
An Advance Directive is a general umbrella term that usually refers to a living will and medical power of attorney/durable power of attorney.
A Living Will is a form that dictates what medical care you do or do not want in the event that you are unable to speak for yourself.
The Medical Power of Attorney (MPOA) is the form that dictates who will make medical decisions for you in the event that you cannot make them for yourself.
It’s best to have both forms (living will and MPOA) filled out to err on the side of caution (for example, if a situation comes up that isn’t addressed within your living will, you want someone that you trust to know your wishes to make that choice for you). You may also come across POLST (Physician Orders for Life-Sustaining Treatment) and DNR/DNI (Do Not Resuscitate/Do Not Intubate).
A POLST form, unlike the living wills and MPOAs, is not something recommended for everyone; in general, these are used for individuals with serious illness and/or frailty ("FAQ," n.d.). It’s important to know that a POLST doesn’t replace a living will but instead, they support each other.
In the event that your breathing and/or your heart stops, medical staff will attempt to resuscitate you unless you have a form indicating otherwise. This form, the DNR/DNI, indicates that you do not want CPR or intubation.
PLEASE NOTE: These forms don’t lock you into your choice. If at any point you decide your wishes and goals for care have changed, you can fill the forms out again and shred the old ones. These are as fluid as you need them to be.
This can be overwhelming even if you have some familiarity with this stuff. Luckily we live in the internet age and there are lots of resources out there to help with all of this! Here are just a few of them:
· A list of state-specific forms can be found here. These forms are available free of charge.
· Five Wishes is an alternative form and can be accessed here. It’s important to know that this document is only accepted in its given form in 40 states (the other 10 require additional documentation, however, this can be attached to the completed and signed Five Wishes document) and neither version (hardcopy or electronic copy) are free.
· National POLST Paradigm has more information on this form and other advance directive information.
· The National Healthcare Decisions Day website has many resources on this topic.
Now that we’ve covered the different document options, stay tuned for part 2 for discussion of information you’ll want to address within those documents (medical power of attorney, body disposition, organ donation, etc.).