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August 14, 2020

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Weekend doctor: Advanced care planning

A series of conversations to help you reflect upon and discuss your goals and wishes around future healthcare decisions

By Amy Mills, RN
Bridge Home Health & Hospice

During this COVID-19 pandemic, multiple aspects of your life have been affected.

You may be thinking, “What kind of healthcare would I choose if I became ill? Who would make my decisions for me if I can’t speak for myself?” Advance care planning and completion of advance directives can ensure that your choices are explored, communicated and documented.

Advance care planning involves a series of conversations to help you reflect upon and discuss you goals and wishes around future healthcare decisions.

These conversations are valuable not only for you, but for your friends and loved ones who could be faced with making decisions for you. Advance care planning takes time and is best accomplished with your friends and loved ones present before you are ill or have a medical emergency.

This allows for thorough understanding and reflection by all who could potentially be involved in the decision making. Advance care planning often results in the completion of advance directive legal documents, which are described below:

Living Will: This document contains your written wishes for medical care, such as life-sustaining treatment and includes artificial/technologically supplied nutrition. The living will is only enacted when someone has a terminal condition or is in a permanently unconscious state, determined by two physicians.

Health Care Power Of Attorney: The purpose of this form is for an individual to be named your advocate in the event you are unable to make your own decision, even temporarily, such as in an accident. This person should know how you feel about life-sustaining treatment and other important issues, such as artificial nutrition.

This person does not manage anything related to your finances. First and second alternates may also be identified, in the event that the primary cannot be immediately reached.

Do Not Resuscitate/DNR: This is a separate physician’s order that is written after discussion with your physician and/or medical team. The DNR form is revocable, meaning that you may change your mind and request resuscitation at any time by speaking with your physician and having a new order written. While most people understand the form as “DNR or Full Code,” decisions regarding the level of intervention is required.

When advance care planning conversations result in the completion of advance directives, it is crucial that these documents be shared. Sharing them with your healthcare providers (local hospital, doctor’s office, emergency medical services) and with your friends and loved ones allows for decisions to be made, if necessary, in line with your wishes.

Documenting and sharing your wishes in advance may reduce preventable suffering for loved ones because the decision is yours, even if you cannot speak.