Advanced Health Directives
Advanced health directives are legal documents that allow people to communicate their wishes for medical care in the event they become unable to make those decisions themselves. There are several types:
A Living Will
A living will allows you to specify exactly which medical interventions you would or would not want administered to prolong your life under certain circumstances. This helps guide doctors and family if you are terminally ill or permanently unconscious.
Some common treatments that a living will addresses include:
CPR - Would you want chest compressions, electric shocks, and breathing tubes if your heart stops?
Ventilator/Respirator - Would you want to be placed on a breathing machine if you cannot breathe independently?
Dialysis - Would you want dialysis if your kidneys can no longer function?
Surgery - Would you want surgeries like having a pacemaker installed or receiving a feeding tube for artificial nutrition?
IV Fluids/Nutrition - Would you want IV hydration and feeding if unable to eat or drink?
Palliative sedation - Would you want medication to induce unconsciousness if experiencing intractable pain?
Your living will can specify whether you would want all measures done to prolong life as long as possible, or whether you prefer only comfort-focused care like pain management if terminally ill. The key is outlining your personalized preferences so they can be honored. Your doctor can help advise on specific scenarios to consider. A living will gives you a voice in your care when incapacitated.
Do Not Resuscitate (DNR)
Do Not Resuscitate (DNR) order involves:
A DNR is a written order that instructs healthcare providers not to perform CPR (cardiopulmonary resuscitation) if your breathing stops or your heart stops beating.
CPR can involve chest compressions, electrical shocks, insertion of a breathing tube, prescription drugs, and other measures aimed at restarting the heart.
Some key reasons a person may opt for a DNR include:
They have a terminal illness and prioritize comfort care. CPR could prolong the dying process.
They have a poor prognosis where CPR has a low chance of success.
They wish to avoid invasive, possibly painful interventions at end of life.
Their frail health makes CPR high risk for injury or survival with poor quality of life.
A DNR can be requested by you or your healthcare proxy, and signed by a physician. It should be immediately accessible in your medical chart.
DNR requests help ensure your wishes around end-of-life care are honored based on your values and priorities.
In summary, a DNR order conveys important decisions about the type of care desired near the end of life, specifically regarding resuscitation practices. Discuss options thoroughly with your doctor.
Durable Power of Attorney for Healthcare
This legal document designates someone to make medical decisions for you if you are unable to do so yourself. It empowers them to act as your healthcare agent or proxy.
The person you choose should be someone you trust completely to understand your values and wishes and carry them out responsibly. Often a spouse, family member or close friend.
The document remains in effect even if you become incapacitated. Your designated proxy can talk to doctors, access records, admit you to facilities, and take any other steps needed for your care.
You can specify limits if desired - what types of decisions your proxy can and cannot make for you. But often it is comprehensive.
The proxy's decisions should align as closely as possible with directions you've outlined verbally or in a living will. They speak for you.
You can appoint backup proxies in case the primary person is unavailable to serve when needed.
Appointing a healthcare power of attorney provides an extra layer of protection that someone you trust will oversee your care according to your wishes if you cannot do so yourself. It's an important consideration.
POLST ( Physician Orders for Life-Sustaining Treatment)
It is a medical order that gives very specific instructions about a person's end-of-life care wishes.
A POLST goes beyond an advance directive by being an actionable medical order signed by both patient/proxy and doctor. It is followed in emergency situations.
It addresses key treatment decisions such as:
Cardiopulmonary resuscitation instructions (CPR yes or no)
Medical interventions like intubation, ventilation, transfer to hospital
Antibiotics, intravenous fluids, tube feeding
Comfort-focused care and pain management
A POLST is designed for seriously ill patients. It allows tailoring orders to your specific medical needs and preferences.
POLST forms are standardized and recognized across care settings and states. The orders follow you wherever you receive treatment.
Having a POLST ensures emergency responders and new providers know exactly what treatments you want and do not want administered.
POLST forms require thoughtful discussion between doctor and patient/proxy. They help ensure your care preferences are honored consistently.
In summary, a POLST translates end-of-life care wishes into actionable medical orders that travel across care settings. This ensures your treatment preferences are clear.
Advanced directives provide you control over your care when you cannot vocalize decisions yourself. They are an important consideration for individuals with serious illnesses to ensure care aligns with their values and preferences at life's end. Advanced directives are valuable for anyone, but especially those with serious diseases like cancer. They allow you to maintain autonomy over your care by specifying what treatments you do or do not want in critical situations where you cannot actively state your preferences. Having clear advanced directives helps guide doctors and family members in aligning medical care with your values.
The requirements for creating advanced directives differ by state but they should be completed thoughtfully in consultation with doctors and family while you are still able to make your own decisions. They can be updated as your situation evolves. Advanced care planning is about understanding treatment options and articulating your wishes in advance.