Common Forms and Terms Regarding Advance Care Planning
Approaching care at the end of life is a complex matter. Although it is hard to talk about the final phase of life, it can be a great gift to our family and loved ones to prepare them in advance for the sometimes difficult and distressing decisions that must be made in regard to future medical care. Advance care planning is an important part of healthcare and is often a difficult subject to approach.
Advance Directives are legal documents by which you may make provisions for future health care decisions in the event that you are unable to make these decisions for yourself. An advance directive lets you decide your wants and wishes for care if you cannot speak for yourself. These legal documents provide instructions for medical care and only go into effect if you cannot communicate your own wishes. Your decision to accept or reject medical treatment really depends upon your personal wishes, values, and beliefs.
Education about common forms and terminology is important for any health care provider to be familiar with. Some common terms and forms are listed below:
CPRor cardiopulmonary resuscitation: is an emergency procedure to restart the work of your heart and lungs by compressing the chest, overlying the heart and forcing air into the lungs. Additional lifesaving procedures include mechanical ventilation or respirator and intravenous medications to regulate blood pressure and heart rhythm
Do Not Resuscitate Order (DNR:) is a medical order written by a doctor. It instructs health care providers not to perform cardiopulmonary resuscitation (CPR) or other lifesaving emergency procedures if your heartbeat or breathing stops. A DNR is arranged with your doctor or health care provider before an emergency occurs.
Do not intubate (DNI) order: A similar document, a DNI informs medical staff in a hospital or nursing facility that you do not want to be on a ventilator
Health Care Proxy: This form allows you to appoint a health care agent—someone you trust to make health care decisions for you if you are unable to do so yourself. In order for the health care proxy to become effective, two doctors must decide that you are unable to make your own decisions.
Living Will: allows you to leave written instructions that explain your health care wishes, especially about end-of-life care. This document becomes effective when you are unable to make your own decisions, and your doctor confirms that you have an incurable condition. You cannot use a Living Will to name a health care agent; you must use a Health Care Proxy form.
MOLST form: Medical Orders for Life-Sustaining Treatment allows doctors to record your preferences regarding cardiopulmonary resuscitation (CPR), mechanical intervention, and other life-sustaining treatments on one form as a physician order. To be valid, it must be completed by a health care professional and signed by a New York State licensed physician.
Power of Attorney: This allows you, the Principal, to appoint an Agent to act for you immediately upon its execution or the occurrence of some future event identified by you. It lasts until you cancel it or upon your death; this power continues when you are mentally or physically incapacitated.
Palliative Care is a multidisciplinary approach to specialized medical care for people with life-limiting illnesses, focusing on providing people with relief from the symptoms, pain, physical stress, and mental stress of the terminal diagnosis.
The World Health Organization defines palliative care as: Palliative care is an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention of and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual (WHO 2002, p 83)
Surrogate is a person close to you, as defined by New York state law, who can make decisions on your behalf if you have lost the capacity to make decisions about your medical treatment, and have not appointed a health care agent.
Five Wishes Document: Five Wishes is unique among all other living will and healthcare agent forms because it addresses all of a person's needs: medical, personal, emotional, and spiritual. It also helps to guide and structure discussions with your family and physician, making conversations easier.
It is s an easy-to-use legal document that helps you express your wishes ahead of a serious illness. In addition to medical and legal issues, Five Wishes deals with matters of comfort and maintaining dignity, as well as the many personal, family and spiritual concerns people say matter most. It is the most popular advance directive in America, and is available in 29 languages. This document is legally valid in almost all states and available in our offices
It is important to understand that advance care planning is not just for people who have a terminal illness. At any age, a medical crisis could leave you unable to communicate your own health care decisions. Planning early for your future health care can help ensure you get the medical care you want and that someone you trust will be there to make decisions for you.
It is also important to choose someone you trust as your health care proxy and discuss your values and preferences with them. These decisions can change with life events or ongoing illness. Know that it is okay to update your wants and wishes for medical treatment. Also, discuss these issues with your providers and supportive care team often so that they are a known element in your care.
References:
https://ag.ny.gov/sites/default/files/advancedirectives.pdf
World Health Organization