Advanced Care

by Julie Fletcher

May 3, 2021

This global pandemic has taught us that we need to be prepared. Not just with supplies and making sure our bodies are strong and healthy, but for the time when we become too ill to make our own health care decisions. A year into this, it’s time to start thinking about Advance Care Directives.

What is an Advance Care Directive?

Every family plans for the future, but have you ever thought about planning for the end? What happens when an accident or disease puts someone in your family in a coma or on life support and they can no longer speak for themselves? The medical care decisions of that family member would fall on you as their next of kin, their immediate family. You need to make sure that if that happens, the decisions you make align with the type of medical care the person would want.

An Advance Care Directive would take care of that. It is a legal document that takes effect when the person concerned is no longer able to make decisions for themselves. The document would state who those decisions pass on to.

Planning for Advance Care involves a serious talk with the family about how each one would prefer their end-of-life care. Having everyone in the family be on the same page helps to avoid unpleasant scenes at someone’s deathbed where the family is surprised and confused by the medical orders doctors are making on their behalf. They may contest the legal wishes especially if they feel it isn’t in their loved one’s best interest.

Some may think of it as morbid, but Advance Care Planning is an important conversation to have so that when the time comes, everyone’s preferred needs are met and the whole family can be at peace.

It’s essentially a living will or a durable power of attorney for health care that tells doctors or a healthcare proxy which treatments and procedures you want and don’t want, in case you are dying or permanently unconscious.

The Advance Care Directive can be adjusted as situations or preferences change and new information becomes known.

Types of Advance Care Decisions

Doctors have many ways, both artificial and/or mechanical, to try and keep their patients alive. This can involve CPR, ventilator use, tube feeding and intravenous fluids, and comfort care.

When you make your Advance Care Directive, you can decide whether or not you want any of the above to be done to you in the event of a serious accident or debilitating disease. It’s best to speak to a healthcare provider you trust to get extensive information about these procedures and to make sure they will carry out the medical orders you chose.

These types of orders include Do Not Resuscitate (DNR) or Do Not Intubate (DNI), organ and tissue donation, and Physical/Medical Orders for Life-Sustaining Treatments (POLST or MOLST).

DNRs tell doctors or medical staff that you don’t wish to be revived if your heart stops beating, whether through CPR or other life-support measures. A DNI tells them you don’t want to be put on a ventilator. Sometimes these orders are called AND (Allow Natural Death).

If you wish to be an organ donor, having this order tells doctors that you allow your organs to be harvested for donation to other people who need them. This usually comes in the form of a donation card that you must always keep in your wallet. Sometimes it’s included in a driver’s license. There is no age limit for organ and tissue donation.

However, in order to keep organs viable for donation, the heart needs to keep beating to pump blood into them. So if you wish to donate and not be resuscitated or intubated, you can indicate that you allow your doctors to put you on a life-support machine until your organs are donated.

If you haven’t made an Advance Care Directive, POLSTs or MOLSTs are forms you can fill out with your doctor when you are in critical condition to give them the medical orders you decide on. However, these forms rely on you still being able to make decisions even when you’re near death.

Advance Care can be planned at any age and sooner is better than later.

How ready are you?

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