Author- Lisa Johnson RN, BSN, CCP
“Advance what,” you say. Advance directives (AD) are the legal documents that convey your end-of-life wishes for healthcare in writing if you can no longer speak for yourself. ADs also allow you to appoint a healthcare agent to ensure your wishes are carried out as you would like. These days a broader term is being applied in some circumstances. That is Advanced Care Planning (ACP). Regardless of the term you use, the endpoint is the same (Wan et al., 2022). Let me share some information about ADs and ACPs.
As the population ages, we find that individuals in their last days, weeks, or months often face the end alone. Patients who have not expressed their preferences for treatment, resuscitation, or artificial life preservation because they believe their time of death is far off are often left with relatives and, in some cases, healthcare professionals making the decisions for them. An AD or ACP is a way for individuals to clearly express how they would like to experience their last days. It is a way to express autonomy regarding how you would like medical treatments to proceed at the end of your life. You can think of it as the one last assertion you make on behalf of yourself (Wan et al., 2022).
Well, “this is a heavy topic,” you think to yourself. While it does require serious consideration, the benefits of putting ADs or ACPs in place are numerous. First, when a family knows how you wish to spend those last days of life, a significant burden is removed from them, knowing that they are not responsible for making those difficult decisions on your behalf. Second, it empowers you as the patient to direct your care in those last precious days. Most importantly, it ensures that your wishes cannot be disregarded and overridden (Wan, 2022).
Here is a quick planning guide to help you start the conversation with family and friends.
THINKING
Think about choices you would make specifically related to medical care, spiritual care, and your surroundings at the end of life.
This would include considerations about CPR, breathing support, food, hydration, and where you would like to be in your final days and with whom. This may also include specifics about the comfort measures you would like to be provided.
CHOOSING
Choose a Healthcare Agent (HCA) or Proxy. This is the person who knows your wishes in detail and can speak on your behalf if necessary. This is often one of the most challenging steps in the process.
An essential step in choosing an HCA is knowing that the HCA is aligned with your wishes and will have the courage to carry them out.
TALKING
Talking about your decisions can feel stressful to you and your loved ones, but the benefits are great.
Share your desires with family members. Planning ahead decreases the likelihood of family disagreements in the overwhelming moments families feel at the end of the life of a loved one.
DOCUMENTING
Put your decisions in writing. Having the legal document at hand removes uncertainty for those around you.
Forms for ADs are available online. Each state has a form that can be downloaded. You can usually complete an AD without the assistance of a lawyer. Two witnesses who are not family members must sign the form to make the AD legal.
Watch as a family has a conversation about putting an AD in place.
Click the link below to see an ABC World News Clip with Diane Sawyer as she follows a family as they discuss and make decisions about end-of-life care. https://www.youtube.com/watch?v=J1r0Xbh0UVo&t=11s
ADDITIONAL RESOURCES
Para obtener información en español, visite este sitio:
https://www.nia.nih.gov/espanol/planificacion-anticipada-cuidados-salud
Included below are links for guide sheets that can be downloaded to assist you as you work through the process.
What to Talk About
https://www.planningmyway.org/en/open-guide-sheet/talk-about
Choosing a Spokesperson
https://www.planningmyway.org/en/open-guide-sheet/choosing-spokesperson
Whom to Contact in an Emergency
https://www.planningmyway.org/en/open-guide-sheet/who-to-contact
Treatment Decisions
https://www.planningmyway.org/en/open-guide-sheet/treatment-decisions
End-of-life Arrangements
https://www.planningmyway.org/en/open-guide-sheet/end-of-life
My Personal Statement
https://www.planningmyway.org/en/open-guide-sheet/personal-statement
Planning My Way Website https://www.planningmyway.org/en
*Information on this site is also available in Spanish https://www.planningmyway.org/esp
The National Hospice and Palliative Care Organization (NHPCO) provides information on Advance Directives with links to each state’s Advance Directive Forms
https://www.caringinfo.org/planning/advance-directives/
Wan, Z., Chan, H. Y. L., Chiu, P. K. C., Lo, R. S. K., Cheng, H.-L., & Leung, D. Y. P. (2022). Experiences of older adults with frailty not completing an Advance Directive: A qualitative study of ACP conversations. International Journal of Environmental Research and Public Health, 19(9). https://doi.org/10.3390/ijerph19095358
“Advance what,” you say. Advance directives (AD) are the legal documents that convey your end-of-life wishes for healthcare in writing if you can no longer speak for yourself. ADs also allow you to appoint a healthcare agent to ensure your wishes are carried out as you would like. These days a broader term is being applied in some circumstances. That is Advanced Care Planning (ACP). Regardless of the term you use, the endpoint is the same (Wan et al., 2022). Let me share some information about ADs and ACPs.
As the population ages, we find that individuals in their last days, weeks, or months often face the end alone. Patients who have not expressed their preferences for treatment, resuscitation, or artificial life preservation because they believe their time of death is far off are often left with relatives and, in some cases, healthcare professionals making the decisions for them. An AD or ACP is a way for individuals to clearly express how they would like to experience their last days. It is a way to express autonomy regarding how you would like medical treatments to proceed at the end of your life. You can think of it as the one last assertion you make on behalf of yourself (Wan et al., 2022).
Well, “this is a heavy topic,” you think to yourself. While it does require serious consideration, the benefits of putting ADs or ACPs in place are numerous. First, when a family knows how you wish to spend those last days of life, a significant burden is removed from them, knowing that they are not responsible for making those difficult decisions on your behalf. Second, it empowers you as the patient to direct your care in those last precious days. Most importantly, it ensures that your wishes cannot be disregarded and overridden (Wan, 2022).
Here is a quick planning guide to help you start the conversation with family and friends.
THINKING
Think about choices you would make specifically related to medical care, spiritual care, and your surroundings at the end of life.
This would include considerations about CPR, breathing support, food, hydration, and where you would like to be in your final days and with whom. This may also include specifics about the comfort measures you would like to be provided.
CHOOSING
Choose a Healthcare Agent (HCA) or Proxy. This is the person who knows your wishes in detail and can speak on your behalf if necessary. This is often one of the most challenging steps in the process.
An essential step in choosing an HCA is knowing that the HCA is aligned with your wishes and will have the courage to carry them out.
TALKING
Talking about your decisions can feel stressful to you and your loved ones, but the benefits are great.
Share your desires with family members. Planning ahead decreases the likelihood of family disagreements in the overwhelming moments families feel at the end of the life of a loved one.
DOCUMENTING
Put your decisions in writing. Having the legal document at hand removes uncertainty for those around you.
Forms for ADs are available online. Each state has a form that can be downloaded. You can usually complete an AD without the assistance of a lawyer. Two witnesses who are not family members must sign the form to make the AD legal.
Watch as a family has a conversation about putting an AD in place.
Click the link below to see an ABC World News Clip with Diane Sawyer as she follows a family as they discuss and make decisions about end-of-life care. https://www.youtube.com/watch?v=J1r0Xbh0UVo&t=11s
ADDITIONAL RESOURCES
Para obtener información en español, visite este sitio:
https://www.nia.nih.gov/espanol/planificacion-anticipada-cuidados-salud
Included below are links for guide sheets that can be downloaded to assist you as you work through the process.
What to Talk About
https://www.planningmyway.org/en/open-guide-sheet/talk-about
Choosing a Spokesperson
https://www.planningmyway.org/en/open-guide-sheet/choosing-spokesperson
Whom to Contact in an Emergency
https://www.planningmyway.org/en/open-guide-sheet/who-to-contact
Treatment Decisions
https://www.planningmyway.org/en/open-guide-sheet/treatment-decisions
End-of-life Arrangements
https://www.planningmyway.org/en/open-guide-sheet/end-of-life
My Personal Statement
https://www.planningmyway.org/en/open-guide-sheet/personal-statement
Planning My Way Website https://www.planningmyway.org/en
*Information on this site is also available in Spanish https://www.planningmyway.org/esp
The National Hospice and Palliative Care Organization (NHPCO) provides information on Advance Directives with links to each state’s Advance Directive Forms
https://www.caringinfo.org/planning/advance-directives/
Wan, Z., Chan, H. Y. L., Chiu, P. K. C., Lo, R. S. K., Cheng, H.-L., & Leung, D. Y. P. (2022). Experiences of older adults with frailty not completing an Advance Directive: A qualitative study of ACP conversations. International Journal of Environmental Research and Public Health, 19(9). https://doi.org/10.3390/ijerph19095358
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