How do you start a conversation about sharing your end-of-life wishes with family or loved ones when you may be strong and healthy and never given it any thought? Have you spent time deciding what matters to you most about your life? What are your values when it comes to making hard healthcare decisions? Advanced care planning is something that is recommended for everyone, regardless of their age and health status.
National Healthcare Decision Day, which was April 16th, was founded in 2008 by Nathan Kottkamp, a Virginia-based health care lawyer, to provide clear, concise, and consistent information on healthcare decision-making to the public, providers, and facilities through the widespread availability and distribution of simple, free, and uniform tools. According to the Patient Self-Determination Act of 1990, all Medicare-participating facilities are required to broach the topic of advanced directives and to provide educational material for residents and patients on this subject to assist them in making decisions on end-of-life care.
Why is it important to let people know your medical wishes?
Making your end-of-life wishes known and documented is very important. Without making these wishes known to a loved one, partner, or friend, you could be in a situation where critical life support decisions need to be made without an appointed person to make them. This puts extreme pressure on your family or partner in a very stressful situation.
During the Covid-19 pandemic, many patients died alone without their wishes known and their families by their sides. Healthcare providers were in a very stressful situation in trying to honor the wishes of dying individuals, but many were on ventilators or unable to verbalize their end-of-life plan.
How can I get started in talking about this sensitive topic with my family?
Starting the conversation about end of life care can be hard for both the patient and the family. There are resources available that make this process easier. One of the resources is a program called The Conversation Project, which strongly believes that this sensitive conversation should start at the kitchen table with loved ones and not in the intensive care unit. The project provides tools in a “starter guide” that includes questions about the quality of life and what that will look like if someone becomes terminally ill.
The Family Caregiver Alliance also has a program, Aging with Dignity that highlights a booklet called The Five Wishes where you can follow the prompts and complete your wishes.
By doing advanced care planning you maintain control of your wishes, gain peace of mind and ensure that your wishes are honored. As a nurse patient advocate, I have witnessed situations when clients were on life support without a clear plan for their families to follow and saw the heartache and trauma this caused.
What documents should every person have in place?
A person should have the following documents in place:
Advance Directive ( Living Will) so you can be specific about what your end-of-life wishes are.
Healthcare Power of Attorney allows a person to designate a healthcare proxy who makes medical decisions for you when you cannot. Take some time and counsel choosing this person. This person may not always be a family member. It should be someone you believe has the strength and integrity to follow through with your wishes.
Durable Power of Attorney is a person that is designated to act on your behalf regarding financial matters if you become incapacitated.
POLST (NJ residents, MOLST for NY residents), which stands for Physician Orders for Life-Sustaining Treatment, is a document you decide upon with your physician which outlines your end-of-life orders. This is frequently kept in a strategic location in the home, such as posted on the refrigerator door. Without this order in place in the home, and a person lives alone, any emergency responders in the event of a life-threatening event are required to perform all resuscitative measures. With that form on the refrigerator, they can follow those instructions specifically.
DNR/DNI Orders, Do not Resuscitate or No CPR, cardiac drugs, or placement of a breathing tube. DNI refers to Do no Intubate, but CPR and cardiac drugs can be used.
Organ Donation Designation Card.
If you are wondering how you will make the right decision on these matters you may want to set up an appointment with an Advance Care Planning Specialist, therapist, Palliative Care Practitioner, or your primary care physician.