Do You Have an Advance Care Directive?

This Critical Document Spells Out What You Want to Occur In Case You Can’t Express Your Own Wishes

Thinking ahead to decisions that may need to be made if you are in an emergency situation or in danger of death is never pleasant but spelling out certain things you wish to happen ahead of time can be a great comfort to you and your family. It can provide your care providers with detailed instructions on what you wish to be done in case you cannot express those desires.

This health care instruction list is called an advanced care directive, and it is an important document to create while you are healthy and can think objectively about your care.

This blog explains what an advanced care directive is, what it should include, and how hospice can address all your questions about end-of-life care.

What Is An Advance Care Directive?

An advance care directive is a set of instructions that detail what sort of care you want in your final days and how you want that care delivered. The document details what actions should be taken to maintain or improve a person’s health if they are not able to express those decisions on their own due to illness or incapacity. Also known as a living will, personal directive, advance directive, advance decision, or medical directive, an advance care directive, in the United States, has the status of being a legal document.

While advance care directives have been around for years, many were discussed only in private. That began to change in 2009, when Barack Obama announced he had a living will and he encouraged everyone to create one. “While no one wants to think about their death,” he said, “creating an advance care directive when you are healthy and thinking clearly is of benefit to you, your family, and your health care providers.”

All states now recognize some form of a living will or advance care directive. Commonly, a living will is left with a loved one who can provide it to health care providers in a time of need, although some states have created registries where the advance care directive can be uploaded so they can be easily and quickly accessed by doctors and other health care workers.

What Should an Advance Care Directive Include?

An advance care directive is a personal document, and it can include almost anything you wish it to include. However, most experts agree that an advance care directive would include these five things:

• A living will: A living will is a legal document that lays out future health care decisions when you are unable to make those decisions on your own. This document is only used when the person is terminally ill or permanently unconscious. The living will describes what sort of treatment you would or would not want in this situation, and under what conditions an attempt to prolong your life should be started or ended. This can include treatments such as the use of feeding tubes or breathing machines. It may also include what sorts of treatment you would like for pain, nausea, or other symptoms. It is important to note that you can end or take back the living will at any time.
• Durable power of attorney or medical power of attorney: This is a legal document in which you name someone to be your proxy – a person who makes all your health care decisions if you are unable to do so. This person will speak on your behalf to make your wishes known based on the contents of your living will. Durable power of attorney laws varies from state to state – your health care team should be able to guide you to an understanding of the rules where you live.
• Physician Orders for Life-Sustaining Treatment (POLST): This is another form that helps describe your wishes for health care, although it is not the same as an advance care directive. This addresses your wishes in an emergency and the use of care such as CPR, if you want to be put on a breathing machine, and other details. This form must be signed by a member of your health care team. It’s important, as some emergency care personnel, such as EMTs and paramedics, cannot use an advance directive but can use a POLST form.
• Do-not-resuscitate (DNR) orders: These are orders signed by you for use in a hospital or outside a hospital that states, if your breathing or heart stops, nothing will be done to keep you alive. If for use outside of a hospital, a DNR order must be accessible by a care provider such as the emergency medical service team that answers a 911 call – this means your order should be worn as a bracelet or visible as a wallet card.
• Organ and tissue donation: Finally, directions for organ and tissue donation, if you want, it can be included in your advance directive. You may be able to also express this wish on your driver's license or on a wallet organ donor card.
  
  

Who Can Help Prepare an Advance Care Directive?

There are many people and organizations that can help you prepare an advance care directive. Since this is an important document that spells out in detail how you wish to be cared for, it is critical that you get the right help in preparing your plan. For some, consultation with their family lawyer may be a good course to follow. However, for those in hospice care, a hospice team may be able to help as well.

To learn more about how the hospice team at Knute Nelson can help you prepare your advance care directive, contact them now. The sooner you begin this important process, the better off both you and your family will be.