End of Life

Planning For Care

Importance of Advanced Care Planning

As hard as it may be to face the idea of death, it is important to plan how we want to live our final days. This includes thinking about what kind of end-of-life care we wish to receive and planning how to pay for it.

People in the U.S. enjoy one of the best life expectancy rates in the world. Barring sudden events such as an accident or heart attack, the end of life will arrive gradually for most. It is likely that each of us will face many decisions about the dying process, for ourselves and possibly for others.

Take some time to consider your wishes at the end of life. Then make sure you talk about what you want with those close to you. This will not only give them peace of mind, but will also help them communicate your wishes to your health care team if you cannot.

Instructions for End-of-Life Care

It is important to have your wishes written down. Instructions that let others know the type of care you want if you are seriously ill or dying are called advance directives.

Advance directives typically include

Living Will

A living will records your end-of-life care wishes in case you are no longer able to speak for yourself. It spells out what life-sustaining treatment you do or do not want if you are terminally ill, permanently unconscious, or in the final stage of a fatal illness. You may wish to meet with your health care provider before preparing a living will to discuss treatment options for a variety of medical situations.

Health Care Proxy

Because it is unlikely your living will can cover every possible situation, you probably want to name someone to make care decisions for you if you cannot. This role is commonly called a health care proxy. Someone in this role may also be called a representative, surrogate, agent, or attorney-in-fact.

You may choose a family member, friend, lawyer, or someone from your religious community to be your health care proxy. You can also name alternates who will serve as your proxy if the primary person is unavailable.

You can name a health care proxy in an advance directive or in a durable power of attorney for health care, a legal document in which you name someone your health care proxy. “Durable” means it remains in effect even if you become unable to make decisions. If the person you choose is not your legal family member, it is important to use a durable power of attorney for health care to name him or her.

Do not confuse a durable power of attorney for health care with a durable power of attorney, which allows someone to make decisions on your behalf regarding property or financial matters in addition to health care.

Make sure to spend time talking with your health care proxy about your wishes, so he or she can feel confident speaking on your behalf if needed.

Do Not Resuscitate (DNR) Order

A Do Not Resuscitate (DNR) order tells health care providers not to perform cardiopulmonary resuscitation (CPR) or other life-support procedures if your heart stops or if you stop breathing. A DNR order is signed by a health care provider and put in your medical chart. Hospitals and long-term care facilities have DNR forms that a staff member can help you fill out. You do not have to have a DNR order.

Physician Orders for Life-Sustaining Treatment (POLST)

A document similar to the DNR is the Physician Orders for Life-Sustaining Treatment (POLST) form. Created specifically for patients with serious, advanced illness, a POLST form provides standing, actionable medical orders concerning end-of-life care. Patients can create a POLST by discussing their treatment options with a health care professional, who then signs the form. Research shows patients using a POLST form are more likely to have their end-of-life care wishes honored.

Preparing Advance Directives

A lawyer can prepare these documents or you can do them yourself. The forms are available on the Internet and from state and local governments. Often these documents need to be witnessed, usually by a public notary, a person who is licensed by the state to witness the signing of legal documents.

Once signed and witnessed, make sure your health care proxy, alternates, and primary health care provider have copies. Hospitals may also request a copy when you are admitted, even if you are not seriously ill.

Revisit Your Advance Directives

It is a good idea to review decisions made in your advance directive from time to time and make changes if your views or health needs have changed. Be sure to discuss any changes with your health care proxy and primary health care provider.

If you live in one state and spend a lot of time in another, make sure your forms are legal in both states. If not, make an advance directive for your non-home state as well. Make sure any family and health care providers there have a copy.