What is advance care planning?
Advance care planning is a process of thinking about what is important to you in your daily life and then sharing your preferred healthcare outcomes with others. This ensures that if others must make medical decisions for you, they can honor what is important to you.
Often advance care planning includes one or more of the following documents which separately or together are called an advance directive:
- The durable power of attorney for healthcare (DPOAH) is a legal document which names one or more individuals who have the authority to make healthcare decisions for you if you cannot direct your care.
- A healthcare directive or living will is another legal document that outlines specific treatments (like hydration and nutrition) for specific circumstances (like a permanently unconscious state).
Sometimes, a medical order for life-sustaining treatment is also completed to direct emergency responders what medical measures to take or not take. Unlike the above documents, this one must be completed with and signed by a doctor, nurse practitioner or physician assistant.
What end-of-life circumstances should be considered?
Each situation and circumstance are unique so no document will be able to cover all possible options. Still, there are several decisions that often come up at the end of life.
- Cardiopulmonary resuscitation (CPR) is used when your heart or breathing stops. t involves deep pushing on your chest to move the blood and can include putting air into the lungs (usually through a breathing tube). Electric shock with a defibrillator or automated external defibrillator (AED) and medications may also be used.
- Ventilation is used to help you breathe. A ventilator, or breathing machine, pushes air into the lungs through a tube through your windpipe. Because the tube is uncomfortable, you would need to be sedated. If a ventilator is needed for a long time, a doctor may perform a tracheotomy directly inserting the tube through a hole in the neck.
- Artificial hydration and nutrition occur when you are no longer able to eat. A feeding tube is placed through the nose to the stomach. If artificial hydration and nutrition are needed for a long period of time, a feeding tube may be surgically inserted directly into the stomach. Additionally, fluids may be given intravenously.
- Comfort care refers to anything that relieves pain and suffering to soothe and relieve you during the end of life. This care should reflect your wishes and could include limiting medical testing; providing spiritual and emotional counseling; giving medication to ease pain, anxiety, constipation, or nausea; and managing other symptoms such as shortness of breath.
- Non-curative treatments are medical treatments that may extend your life but will not cure the condition causing death. These treatments can incorporate palliative care to help ensure a quality of life which aligns with your values, preferences and beliefs.
How can you start an end-of-life conversation?
It may feel awkward to just start talking about end of life while eating turkey or opening presents, but it doesn’t have to be. Some easy starter questions are:
- What are three things that everyone should know about you? (This highlights someone’s fundamental values.)
- What brings you joy every day? (This focuses on what activities are important and what outcomes would be needed by any medical decisions.)
- It’s been a crazy two years; how do you find calm? (This shows what to do to help bring comfort and solace.)
Be prepared to share your own answers and why it’s important to discuss end-of-life plans. Remember, it doesn’t have to happen all in one conversation; you can have many dialogues about it!
The holidays are the perfect time to discuss what is most important to you, so the end of life can reflect who you are and what you want. So, gobble up the festive meal and take time to talk turkey about end-of-life options. It’s the gift people need.