While occasional spontaneity adds a necessary spice to life, as a rule, human beings are planners, especially when it comes to life’s biggest events. From educational and career paths to marriage, family vacations and retirement, planning allows us to be confident in where we are going and to be successful along the way. So, why do so few people apply the planning principle to something as important as discussions regarding their wishes for end-of-life care? Approximately two out of three American adults have not completed any type of advance care directive to help plan for their medical care at end-of-life nor considered the possibility of a medical crisis.
It is understandable that a person’s natural inclination may be to avoid a discussion about the wishes they have for themselves at the end of their life, feeling that this may somehow bring death closer, sooner. However, planning ahead by developing clear, concise directions for your care is one of the most proactive things you can do for yourself—and for your loved ones, who may be asked to make these important decisions on your behalf.
Documentation of your wishes will allow you to guide your medical team and your designated decision-maker in the event of a poor prognosis, chronic illness or traumatic incident. It will enable the person you choose as your healthcare proxy to make decisions for you based on a discussion regarding your wishes.
When a person is near death and unable to make their wishes known, the medical provider will look to the immediate family or designated decision-maker to decide how to move forward, for example, to continue all aggressive measures to prolong life, like CPR, intubation, placement of a feeding tube, or continuation of dialysis, versus a focus on comfort and dignity at this time in their life and illness. If this topic has never been addressed, the surrogate decision-maker now has the overwhelming task of attempting to determine what their loved one may want. This often leaves the decision-maker feeling the burden and guilt of their decisions, unsure if what they are deciding is really supporting what the patient would want.
The benefits of advance care planning are so important that every April 16 we observe National Healthcare Decisions Day, an initiative designed to encourage more adults to have the conversation about end-of-life care, plan their advance care directives and take steps to complete the appropriate documents to ensure the care they want is the care they receive.
A good place to start is with the “Three W’s” of planning for peace of mind.
Advance care planning is a part of personal healthcare that any adult can, and should, pursue. Having a plan in place becomes more important as a person ages. People who are living with or are at risk for serious health conditions should also prioritize advance care planning. However, even young adults and people who are healthy can benefit from having a plan in place. No one likes to think about it, but tragic accidents or life-changing events can happen to anyone at any time. An advance directive helps to eliminate the burden of decision-making, provided a conversation has been held involving the patient and the proxy.
Developing an advance care plan, also known as an advance directive, can be less complicated than you may think. In fact, forms to guide you in the process are linked below. However, it is recommended that you complete these forms with input from your healthcare provider and an attorney to ensure you’ve addressed a comprehensive list of medical care needs and possible outcomes.
There are two parts to an advance care plan. The first is a living will, which will “speak” for you if you are unable to. This document outlines your choices for the treatment and other aspects of care you want your medical team to provide, or not provide. You’ll have to make certain types of decisions when developing your living will, including if you want to be placed on a breathing machine, whether you want to be resuscitated if your heart stops, and what treatment would be acceptable to you if there was a decline in your quality of life. A living will can be updated at any time and should be reviewed regularly.
The second part of an advance care plan is a healthcare power of attorney. This legal document empowers a person of your choosing—known as your “agent” or “proxy”—to implement your medical choices. The person you choose for this responsibility should be someone you trust and who understands and respects the choices you make for your end-of-life care. While many people choose a family member for this role, it is not required that an agent be a relative by blood or marriage.
The best time to develop an advance care plan is while you are healthy and able to make your wishes known—and not under the stress of an illness, surgery or treatment for what may be a life-limiting disease.
This April, Garnet Health encourages adults in the communities we serve to advance the mission of National Healthcare Decisions Day. If you don’t have an advance care plan in place already, get started on your living will and healthcare power of attorney, with forms available for the state of New York on these sites: