Advance Care Planning: One of the most important decisions of your life

By Charlotte Michos RN, MS, CNS, CLNC  |  4/14/2015
People are often ill at ease about discussing death. Yet death is inevitable — the one thing that we all have in common. As a nation, we do not have a great track record of communicating our end-of-life decisions should we ever be in a medical crisis. A good time to make a change is April 16th, National Healthcare Decisions Day.

Advance Care Planning is the process of planning for future medical care in case you are unable to make your own decisions. It includes several legal forms that document your medical care decisions, also known as “advance directives.” These forms are legal documents, but do not require legal services to be completed, nor do they have to be notarized. And if your wishes change at any time, you can revise these forms. While there may be some variation from state to state, these forms include the healthcare proxy, living will and MOLST.

Health Care Proxy

This is a simple legal document that allows you to assign a spokesperson who will make medical decisions for you when you are unable to make your own. It includes your name, the spokesperson’s name and two people who witness your signature. Store this form with your important documents and maintain copies in key locations. Give your physician one to keep in your medical file and provide one to your spokesperson (also known as a healthcare agent). You might also want to keep one on your refrigerator door where it is easily visible in an emergency situation. 

Living Will

A living will is a statement of medical care you wish to receive. It can be as simple or as complex as you choose. It is best to research this subject and become informed about the decisions you want to make regarding life-saving measures such as defibrillation, intubation, feeding tubes, etc. Compassion and Support is a great place to start.

MOLST

Less familiar to the public is MOLST (Medical Orders for Life-Sustaining Treatment). This document lists specific life-sustaining treatments you wish to receive (or not) and is completed as an order by your physician, based on your input. The advantage of the MOLST form is that it becomes effective immediately after it is signed, and it is honored in all settings. The MOLST form does not replace the other advance directives, but actually complements the Health Care Proxy and Living Will. The New York eMOLST Registry gives 24/7 access in an emergency whether you are home, at the hospital, nursing home or other location. 

Palliative Care

In addition to completing forms for Advance Care Planning, you should also think about whether you want to receive Palliative Care. The World Health Organization defines palliative care as “an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.” Unlike hospice care, palliative care can be started at any age, at any stage in a serious illness and can be combined with curative care. Palliative care is sometimes referred to as “comfort care.”

In 2010, a Temel study  found that comfort care resulted in a reduction of patients’ symptoms, improved quality of life, and reduced hospitalizations, as well as healthcare costs. As part of the study, people also lived three months longer (median survival) when they were on comfort care, which was an unexpected discovery.

Peace of Mind for You and Your Family

We accept the importance of planning in many aspects of our lives. So we should equally accept advance care planning, which is not about “giving up.” If anything, it is the opposite. It is about ensuring less chaos at the time of death, helping achieve peace of mind for ourselves and our loved ones, and ensuring that our wishes will be honored.