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Advance Care Directives: Preparing for the Unknown

 

The truth is you don't know what is going to happen tomorrow. Life is a crazy ride, and nothing is guaranteed.

– Marshall Mathers III

Life is uncertain. It is impossible to predict what tomorrow may bring. Regardless of your age, planning for the unknown is important. It can ensure your loved ones never have to guess what you would want in an emergency.

Advanced care planning is not just about old age or illness. It’s about protecting yourself and your loved ones in the face of the unexpected. Currently, only 25 percent of Americans have end-of-life medical wishes recorded in legal documents. (Source: AgingCare)

What is Advance Care Planning?

Advance care planning (or advance directive) is a legal document, or a series of documents. They spell out exactly what you want—or don’t want—should you be unable to decide for yourself. These documents serve as guidance for family members and medical professionals.

In an emergency, advance care directives can provide guidance with things like:

  • Using ventilators
  • CPR
  • Pain care
  • Organ and tissue donations

These documents go by different names depending on the state in which you live. But they usually have two main components: a living will and a durable power of attorney for health care. Additional documents may be added. (Such as: a do-not-resuscitate (DNR) order, physician order for life-sustaining treatment (POLST) forms, etc.)

You should consider advanced care directives as living documents. They should be updated and adjusted over time as your situation and health changes. Your wishes may very well change as you age. What you do or do not want at thirty will likely be different than at seventy. We think it’s a good idea to review them on a regular basis, perhaps anytime you review your estate or financial plans.

State laws vary but your advance care directives must follow current requirements. An attorney can assist you with this. (Please book a call if you would like help finding one.) But don’t expect a lawyer to explain the different medical treatments you are deciding about. They probably will not know enough to help you make an informed decision.

Each state also has their own generic forms available online [link]. If you spend a lot of time in another state, snow-birding or visiting family, have paperwork in place for each location.

It is important to note that if you do not have a proxy and/or living will, doctors are legally required to pursue all viable life-sustaining treatment options.

What is a living will?

A living will states your medical wishes and will guide your medical care if you become unable, physically or mentally, to express them.

What is a durable power of attorney for health care?

A durable power of attorney for health care, also known as a health care proxy, designates who can act on your behalf if you are unable. You decide how much authority they have and what decisions they can make for you.

Your proxy (also known as representative, surrogate, or agent) may be a family member, friend, lawyer or someone else. It’s a smart idea to name an alternative proxy. When you choose your proxies, consider someone who is health and/or financially minded. Make sure your proxy and alternative know your specific wishes, have a copy of the document, and are comfortable with the responsibility.

If you choose not to appoint a proxy, you must be more detailed in your living will.

How to get started

The advance care planning process involves three basic parts. First, you need to educate yourself about what types of decisions might need to be made. If you aren’t sure where to begin, and have current medical conditions, use this information to start. If you don’t have any medical issues, look at your family history. It might provide a clue to what you could face in the future, like heart disease.

Second, consider the decisions ahead of time. What kinds of treatment do you want in an emergency? What treatments do you not want? Asking your doctor to help you understand your choices before you put them into writing is a good idea. For example, if strokes run in your family, what decisions would you face if you experienced one.

In considering treatment options, think about your personal values and what “quality of life” mean to you. Would you want to receive CPR if your heart stops? What about being on a ventilator? These are just a few things to consider. Not all your potential decisions are this extreme. An advance care directive allows you to outline instructions for any situation you choose, from CPR to the use of pain medication.

Finally, you need to make your wishes known. This step is vital. Your physician should have a copy of your wishes. If you are admitted to a hospital, give the facility a copy of your advance care documents for your medical chart.

It is crucial in advance care planning to discuss your personal preferences in detail with anyone who serves as your proxy. You should also make sure your friends and family know your wishes. We realize this isn’t an easy conversation. If you have trouble, one helpful suggestion we found was to make a video for your loved ones to watch. How ever you do it, make sure your friends and family understand your wishes. This can help prevent conflict later.

Uncertainty always creates doubt, and doubt creates fear.

- Oscar Munoz

“Just-in-case”

Everyone hopes they never need advance care directives. But the uncertain future can cause anxiety. This small piece of planning can give you and your loved ones peace-of-mind.

You have the right to decide what care and treatment you receive. Advance care can ensure you have your say, even if you cannot communicate your wishes. Remember, in the absence of a proxy and/or living will, doctors are legally required to pursue all viable life-sustaining treatment options.

More resources:

If you live in Indiana, check out this brochure and/or resource center to provide information.

You can also find Indiana’s generic forms here. At the very least, you should complete one of these very basic forms.

If you do not live in Indiana, you can find your state's generic forms here.

The National Institute on Aging has this helpful guide and printable wallet card.

You can also find more information at the following sites:

 

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