End-of-Life Care: Why Planning Matters
Advance care planning expresses your wishes
Advance care planning expresses your wishes
Planning for medical care at the end of life can bring some comfort and clarity during a difficult time. You don’t have to wait until you’re very sick to discuss your end of life wishes. In fact, it’s best to have these conversations before needing hospital or nursing home care.
An advance health care directive lets you say what medical treatment you want or don’t want if you become severely sick. You can change or cancel your directive at any time as long as you can communicate your wishes.
“Advance directives are vital documents that help clarify a person’s wishes regarding their health care,“ says Vishva Lakshman, MD, a palliative medicine specialist at Scripps. “It guides the family and health care team when a person is no longer able to express their wishes.“
Despite their benefits, advance directives are underused. Only about a quarter of adults in the United States have recorded their end-of-life care choices, according to one study.
How does and advance directive work?
An advance directive is a legal document that says what medical care a person wants in the event they become too ill or injured to communicate and can’t make decisions anymore.
Advance directives typically cover decisions regarding life-sustaining treatments, resuscitation, pain management and organ donation.
The two most common advance directives indicate a patient's medical wishes and assign a person who can make health care decisions if they cannot do so themselves. In California, they are known as the Individual Health Care Instruction and Power of Attorney for Health Care. They can be used together or alone.
“Having a conversation about your choices with a loved one is difficult but it will help guide them should the need arise,“ Dr. Lakshman says.
Individual health care instruction
This directive helps to make sure the patient’s wishes are met. This includes whether the patient wants to be resuscitated or put on a ventilator or allowed to pass away naturally.
This document helps health care professionals and family members take care of the patient’s pain, spiritual needs and comfort.
Power of attorney
Power of attorney designates a trusted individual or agent to make medical decisions on behalf of a dying person when they are no longer able to do so.
The designated person, usually a family member or friend, should understand the patient’s wishes and values for medical care. Medical teams must follow their decisions unless a requested treatment would be ineffective or harmful.
What is a POLST form?
Another form to consider, when appropriate, is known as a Physician Order for Life-Sustaining Treatment (POLST) in California. It is also known as portable medical orders or physician orders for scope of treatment.
A POLST form complements an advance directive and does not replace it. A health care provider discusses options and preferences with the patient before the form is signed.
A POLST form provides more specific information about treatment wishes that health care providers can act on immediately in an emergency. It is designed to help people who are seriously ill or medically frail.
The form is a physician’s medical order. It remains with patients wherever they receive care and must be honored.
Where can I find a form for advanced directives?
Patients 18 and older may obtain these forms from their physicians or health care system. Once completed, patients should record them in their medical files, and give copies to their agents and family members. Patients may change or cancel them, provided they can competently communicate their wishes.
“It is important to have a conversation with your clinician about your health and what type of care you would want. Advance directives and POLST forms are a way to communicate these health care choices. They also designate who would help with decisions if you were no longer able to express your goals,” Dr. Lakshman says.
Additional assistance and resources are available at the National Hospice and Palliative Care Organization.