© Robert Kneschke | Dreamstime.com
Whether you’re caring for elderly parents at home or planning for yourself, it’s important to make decisions and preparations for end-of-life issues.
These measures can help ensure that your parents—or you—receive the proper care while making decisions easier for loved ones. Experts advise us that the best time to begin making these decisions is when you’re healthy. And it’s best to tackle the chore via advance directives.
If you’re not familiar with the phrase, advance directives are written statements of an individual’s wishes regarding medical care. These directives ensure that a person’s wishes are carried out should that individual not be able to communicate them to his or her doctor.
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Types of Advance Directives
The two types of advance directives that most physicians recommend are as follows:
- Living will: A living will is a form that states your wishes regarding different forms of end-of-life care. You can state whether or not you would like to receive resuscitation (with CPR or an automated defibrillator) to restart your heart if it were to stop beating, tube feedings (through a tube passed into your stomach from your nose or through the abdominal wall) if you are no longer able to eat, dialysis if your kidneys stop working, mechanical ventilation if you are no longer able to breathe on your own, or antibiotics/antiviral medications for infections. You can also specify your wishes about what kind of palliative or comfort care (e.g., pain medications) you would like to receive if you do not wish to have more invasive measures taken.
- Living wills are also opportunities to state whether or not you would like to donate your organs or tissues for organ transplantation or your body for medical research. Living wills cannot be used for medical decision-making until two physicians have certified that you are unable to make medical decisions and that you are in a medical condition specified by your state’s living will law.
- Medical power of attorney/healthcare proxy: When you appoint someone your healthcare proxy you are making them your surrogate decision-maker and authorizing them to make medical decisions on your behalf in the event that you are unable to make them. When you select your healthcare proxy, it is wise to select someone you know well and who understands your wishes, who will not be afraid to advocate for you with your doctor, who communicates well with your family, and who is calm in a crisis.
What You Should Know
There are several important things to know about advance directives. Paramedics cannot honor either your living will or medical power of attorney. If they are called to attend to an emergency, they must provide emergent care until they have taken you to a hospital where a physician can then be made aware of your advance directives.
Laws regarding advance directives differ from state to state and some states will not honor an advance directive from another state. If you spend a good deal of time in more than one state, it is wise to have an advance directive for each state. You do not need an attorney to create an advance directive although many people do have an attorney help them create one.
Your physician or local hospital can direct you to organizations that provide state-specific advance directive forms or you can visit www.caringinfo.org to obtain free advance directive forms. You will have to have witnesses for all advance directive forms and it is important to be sure that your witnesses comply with your state’s requirements.
Where you keep your advance directives is also critically important. It is wise to make copies and give them to your family members, your healthcare proxy, your physician, and your family attorney. Since advance directives contain information regarding matters of life or death, it is important to review your advance directives periodically to be certain they still reflect your wishes.
What If I Don’t Have an Advance Directive?
If you don’t have an advance directive and become ill, there are still opportunities to make your wishes regarding the type of care your receive known.
- “Do Not Resuscitate” (DNR) orders: If you do not wish to be resuscitated with CPR or a defibrillator should your heart stop beating, you can discuss this with your physician and he or she can put a DNR order in your medical record.
- Physician Orders for Life-Sustaining Treatment (POLST): A POLST is the product of a discussion between an ill patient and their healthcare provider about the patient’s wishes, goals for care, and beliefs and the physician’s knowledge about the patient’s diagnosis, prognosis, and treatment options. Together, the patient and physician reach an informed decision about desired treatment and create a set of medical orders that reflect those decisions.
Originally published in May 2016 and updated.