Many Americans will face questions about medical treatment but may not be capable of making those decisions—for example, in an emergency or at the end of life. The following information from the National Institute on Aging explains the types of decisions and questions to think about now so you’re prepared later.
It’s important to remember that advance care planning is not just about old age. At any age, a medical crisis could leave you too ill to make your own healthcare decisions. And remember that an advance directive is only used if you are in danger of dying and need certain emergency or special measures to keep you alive, but you are not able to make those decisions on your own.
What is advance care planning?
Advance care planning involves learning about the types of decisions that might need to be made, considering those decisions ahead of time, and then letting others know—both your family and your healthcare providers—about your preferences. These preferences are often put into an advance directive, a legal document that goes into effect only if you are incapacitated and unable to speak for yourself.
Advance care planning decisions
Sometimes decisions must be made about the use of emergency treatments to keep you alive. Doctors can use several artificial or mechanical ways to try to do this. Decisions that might come up at this time relate to:
- CPR (cardiopulmonary resuscitation)
- Ventilator use
- Artificial nutrition (tube feeding) and artificial hydration (IV, or intravenous, fluids)
- Comfort care—anything that can be done to soothe you and relieve suffering while staying in line with your wishes
Start by thinking about what kind of treatment you do or do not want in a medical emergency. It might help to talk with your doctor about how your current health conditions might influence your health in the future. Discussing advance care planning decisions with your doctor is free through Medicare during your annual wellness visit. Private health insurance may also cover these discussions.
Making your advance care wishes known
You can choose which documents to create, depending on how you want decisions to be made. These documents include:
- Living will. This is a written document that tells your doctors how you want to be treated if you are dying or permanently unconscious and cannot make your own decisions about emergency treatment.
- Durable power of attorney for healthcare. This is a legal document naming a healthcare proxy—someone to make medical decisions for you at times when you are unable to do so. Your proxy, also known as a representative, surrogate, or agent, should be familiar with your values and wishes.
- Other documents. A living will usually covers only the specific life-sustaining treatments discussed earlier. You might want to give your healthcare proxy specific instructions about other issues, such as blood transfusion or kidney dialysis, especially if your doctor says you might need such treatments in the future.
Medical issues that might arise at the end of life include:
- DNR orders. “Do not resuscitate” orders tell medical staff that you do not want them to try to return your heart to a normal rhythm using CPR or other measures.
- Organ and tissue donation allows organs or body parts from a generally healthy person who has died to be transplanted into people who need them.
- POLST forms. In California, the POLST (physician orders for life-sustaining treatment) form provides guidance about your preferences in the form of a doctor’s orders. Typically you create a POLST when you are near the end of life or critically ill and know the specific decisions that might need to be made on your behalf.
Making your healthcare directives official
The next step is to fill out the legal forms detailing your wishes. A lawyer can help but is not required. The State of California provides info and links to forms. Your local area agency on aging can help you locate the right forms. You can find your area agency phone number by calling the Eldercare Locator at 1-800-677-1116 or by visiting https://eldercare.acl.gov.
What to do after you set up your advance directive
Give copies of your advance directive to your healthcare proxy, your alternate proxy and your doctor. Tell close family members and friends where you keep a copy. If you have to go to the hospital, give staff there a copy to include in your records.
More details are available from the National Institute on Aging website.