Aging, facing health issues, or watching your loved one receive a difficult diagnosis, is not easy under any circumstances, but when that journey includes difficult decisions that have not been discussed or planned for, that journey becomes even more challenging. It may be hard to believe, but a few forms prepared prior to an illness or diagnosis can provide guidance as well as comfort to you and your loved one. So, what is a Healthcare Directive? The directive can be a variety of legal documents that explain what kind of medical or end-of-life treatment you want for yourself. These documents give guidance to your doctor or any medical staff treating you as well as your family members. A directive can also specify who can make medical decisions on your behalf if you are unable.
Some of the most common Healthcare Directives are:
- Living Will
- Medical Power of Attorney
- DNR – Do Not Resuscitate
- DNI – Do Not Intubate
- POLST – Physician Orders for Life Sustaining Treatment
Living Will – a legal document in which the signer requests to be allowed to die rather than be kept alive by artificial means if disabled beyond a reasonable expectation of recovery.
Medical Power of Attorney – a power of attorney that is authorized as an agent to make health care decisions in the event of incapacity.
DNR – is a legally binding physician’s order stating that no steps will be taken to restart a patient’s heart or restore breathing if the patient experiences cardiac arrest or respiratory arrest.
DNI – is an order that means that chest compressions and cardiac drugs may be used, but no breathing tube will be placed.
POLST – is a legal form that gives extremely frail and advanced progressive or terminally ill patients control of their end-of-life care in an emergency medical situation. The goal of a POLST form is to prevent unwanted treatments, reduce patient suffering, and ensure that the patient’s wishes are honored.
Each of these forms make up a larger plan and are used at different times in different ways. The Living Will, for instance, is a document and stated intention for future use if necessary. A POLST is an action plan for immediate care of someone at a clear terminal or end of life stage. Each of these documents, and the overall health care plan, can bring up difficult conversations and confront challenging realities. While it is best practice for all adults to have some form of Living Will directive in place in case of an unexpected accident, the reality is that most do not. And the reality is that most of these forms are not contemplated, let alone, exercised until there is a diagnosis or trauma ahead. No one wants to plan for incapacitation or death but having a plan before you need it can be the difference between a peaceful journey or one laden with confusion and frustration.
The first step to building your advanced care plan is to spend some time thinking about what is most important – to you if planning for yourself or discussing with your loved one if planning is for them. Often, a lot of focus is put on the medical diagnosis and prognosis with little consideration for the quality of time and life. Being clear on the priority of quantity vs. quality is critical for anyone’s care plan.
After creating some clarity for yourself and/or your loved one, the second step is to discuss with your primary doctor. They can discuss the options, the forms, and the plan with you and your family so that everyone is clear on the plan and the desired outcome. When my mom’s doctor recommended a POLST due to the severity of her advanced Alzheimer’s and a related physical condition, we had never heard of this form or approach. At first, we were hesitant as it felt like giving up, but after he explained that the suffering she was experiencing would only be extended without the clarity of this action plan in collaboration with our hospice team, we were thankful for his focus and priority on her care and comfort.
Once you have decided on what plan and forms are best suited for your specific case, you can prepare the forms with the help of an estate attorney, medical staff, and/or online documents such as those found here from AARP (Association of American Retired Persons). Please note some of the forms require witnesses to your signature and others may require a notarization.
As with everything, a little preparation can go a long way, especially during a difficult time. And, as always, listening to our loved ones and respecting their personal wishes for how they want to move through their health and end-of-life journey is the most important.
Time is finite. Love is eternal. Forgiveness is everything.