Advance Care Planning: Medical Care at the End of Life

Advance Care Planning: Medical Care at the End of Life

What is advance care planning?

Talking with your doctor about your wishes for medical care at the end of your life is called advance care planning. It’s a way for you and your doctor to discuss the kinds of care you want and the kinds of care you don’t want at that time. You can tell your doctor about the care you would want if you become unable to make decisions because of a coma or another medical condition that leaves you unable to decide or to speak for yourself. When you write down your wishes, this kind of plan is called an advance directive.

What is an advance directive?

An advance directive is a form that tells your doctor and your family members what kind of care you would like to have if you become unable to make medical decisions. It’s called an advance directive because you choose your medical care before you become seriously ill.

When you’re admitted to a hospital, the staff must tell you about advance directives. The laws about advance directives are different in each state. Ask your doctor what the laws for advance directives are in your state.

An advance directive lets you say you don’t want a certain treatment, such as cardiopulmonary resuscitation (also called CPR). For example, if you have a fatal illness and are near death, you may not want to have CPR if your heart stops. An advance directive can also say that you do want certain treatments, like medicine for pain, or intravenous fluids and tube feedings.

An advance directive also lets you name someone, like your spouse or another close family member, to make decisions for you if you lose your ability to communicate. This is called a durable power of attorney for health care.

What is a durable power of attorney for health care?

A durable power of attorney for health care (also called a DPA) lets you name someone to make medical decisions for you if you are unconscious or unable to make medical decisions for any reason. A DPA can be part of the advance directive form. If you don’t know a person you can trust to make these decisions for you, the DPA may not be right for you.

What is a living will?

A living will is another kind of advance directive. It only comes into effect if you’re terminally ill. Being terminally ill generally means that you have less than six months to live. In a living will, you can say what kind of treatment you want in certain situations. In this way, a living will is like an advance directive. But a living will doesn’t let you name someone to make decisions for you. A DPA is generally more useful than a living will because a DPA lets you name someone to make decisions in your behalf.

If I’m healthy, why should I make an advance directive?

When you’re healthy, it’s hard to think about the care you want at the end of your life. But it may be the best time to make these decisions. An accident or serious illness can happen any time. Talking with your doctor now gives you a chance to ask questions and talk about your concerns. If you do this when you’re healthy, you’ll be thinking clearly as you talk about this important topic.

Who needs an advance directive?

Most advance directives are written by older people or by people who are seriously ill. For example, a patient in the last stage of cancer might write an advance directive that says she doesn’t want to be put on an artificial respirator if she stops breathing. By letting her doctor know ahead of time that she doesn’t want a respirator, she may be able to reduce her suffering at the end of life and increase her control over her death. It may give her peace of mind to know that her doctor knows her wishes and that she won’t be put on a respirator if she stops breathing.

How can I write an advance directive?

You can write an advance directive in several ways:

* Ask your doctor for a form for writing an advance directive.

* Write your wishes on a piece of paper, sign it and date it.

* Call your state senator or state representative to get the right form.

* Call your lawyer to help you write an advance directive.

* Use a computer software package for legal documents.

Advance directives and living wills are not complicated. They can be short, simple statements about what you want done or not done if you can’t speak for yourself. Remember, anything you write by yourself or with a computer software package should follow your state laws. So, find out what the laws are in your state. If possible, get your advance directive notarized. Give copies to a family member and to your doctor.

Sample Advance Directive Form

This form is a combined durable power of attorney for health care and a living will (in some jurisdictions). With this form, you can name someone to make medical decisions for you if in the future you’re unable to make those decisions yourself. You can also say what medical treatments you want and what medical treatments you don’t want if in the future you’re unable to make your wishes known.

Instructions

Read each section carefully. Before you fill out the form talk to the person you want to name, to make sure that he/she understands your wishes and is willing to take the responsibility. Write your initials in the blank spaces before the choices you want to make. Write your initials only beside the choices you want under Parts 1, 2 and 3 of this form. Your advance directive should be valid for whatever part(s) you fill in, as long as it is properly signed.

Add any special instructions in the blank spaces provided. You can write additional comments on a separate sheet of paper, but you should write on this form that there are additional pages to your advance directive. Sign the form and have it witnessed. Give copies to your doctor, your nurse, the person you name to make your medical decisions for you, people in your family and anyone else who might be involved in your care. Discuss your advance directive with them.

Understand that you may change or cancel this document at any time.

Definitions to Know

Advance directive–A written document (form) that tells what a person wants or doesn’t want if he/she in the future can’t make his/her wishes known about medical treatment.

Artificial nutrition and hydration–When food and water are fed to a person through a tube.

Autopsy–An examination done on a dead body to find the cause of death.

Comfort care–Care that helps to keep a person comfortable but doesn’t make him/her get well. Bathing, turning and keeping a person’s lips moist are types of comfort care.

CPR (cardiopulmonary resuscitation)–Treatment to try to restart a person’s breathing or heartbeat. CPR may be done by pushing on the chest, by putting a tube down the throat or by other treatment.

Durable power of attorney for health care–An advance directive that names someone to make medical decisions for a person if in the future he/she can’t make his/her own medical decisions.

Life-sustaining treatment–Any medical treatment that is used to keep a person from dying. A breathing machine, CPR, and artificial nutrition and hydration are examples of life-sustaining treatments.

Living will–An advance directive that tells what medical treatment a person does or doesn’t want if he/she is not able to make his/her wishes known.

Organ and tissue donation–When a person permits his/her organs (such as the eyes or kidneys) and other parts of the body (such as the skin) to be removed after death to be transplanted for use by another person or to be used for experimental purposes.

Persistent vegetative state–When a person is unconscious with no hope of regaining consciousness even with medical treatment. The body may move and the eyes may be open, but as far as anyone can tell, the person can’t think or respond.

Terminal condition–An ongoing condition caused by injury or illness that has no cure and from which doctors expect the person to die even with medical treatment. Life-sustaining treatments will only prolong the dying process if the person is suffering from a terminal condition.

This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject. Copyright [C] 1999 American Academy of Family Physicians. Permission is granted to reproduce this material for nonprofit educational uses. Written permission is required for all other uses, including electronic uses.

This handout is provided to you by your family doctor and the American Academy of Family Physicians. Other health-related information is available from the AAFP on the World Wide Web (http://www.aafp.org/healthinfo).

COPYRIGHT 1999 American Academy of Family Physicians

COPYRIGHT 2000 Gale Group