Ohio Department of Aging Aging Connection - April 2009

April 2009

Advance Care Planning: Making Health Decisions Known

Today, advances in medicine and medical technology save lives that only 60 years ago might have been lost. Unfortunately, sometimes this same technology also artificially prolongs life for people who have no reasonable hope of recovery. As our population ages and medical technologies continue to evolve, discussions about what kind of care we want at the end of life are increasingly important. Confusion about what medical choices to make for a person who cannot communicate his wishes can make an already challenging situation worse.

It happens more often than we would like to think. In 2006, the Pew Research Center reported that 42 percent of Americans have had a friend or relative suffer from a terminal illness or coma in the last five years, and for a majority of these people, the question of withholding life-sustaining treatment came up.

The best time for an individual to make end-of-life decisions is when he is healthy, long before those decisions are needed. Advance care planning is more than just securing the proper legal documents. It requires research, preparing and talking to family members and friends, so that health decisions are made in a manner consistent with what a person wants. Such planning will give loved ones the guidance they need when making difficult decisions about end-of-life care, ensuring that an individual's wishes are known and followed, if he cannot communicate those choices himself.

Advance care planning is not just about end-of-life care. It is a process to document how a person would like to be treated in case he is not able to express his wishes. The plan can include anything from dietary preferences to sleep and awake times, as well as end-of-life decisions.

In addition to open discussions with family, friends and healthcare providers, individuals need to document their preferences and treatment wishes by creating advance directives, which include:

• A living will, which describes the types of medical treatments you would or would not want if you were seriously or terminally ill. You can accept or refuse medical care, including the use of dialysis and breathing machines, resuscitation if breathing or heartbeat stops, tube feeding and organ or tissue donation.
• A durable power of attorney, which names someone to make health care decisions for you and becomes active any time you are unconscious or unable to make medical decisions for yourself. A durable power of attorney is an important companion to a living will, but only if you have someone you trust to make these decisions for you. Make sure they know you have given them this responsibility.
• A Do Not Resuscitate (DNR) order, which must be signed by a physician, dictates the amount of care you would receive under certain conditions of cardiac arrest - chest compressions or just comfort care, for example. It allows a person to refuse, in advance, any effort to resuscitate in the event of a cardiac or respiratory arrest.

Health care providers need to be aware of an individual's choices. The U.S. Agency for Healthcare Research and Quality estimates that between 65 and 76 percent of physicians whose patients did have an advance directive were not aware that it existed, and only 12 percent of patients with an advance directive had included their doctors in developing it. In a medical emergency, when health care providers are not aware of any health care directives, they are obligated to take all measures possible to save a patient who is unable to communicate.

Advance directive forms and more information can be found on the Ohio Hospice and Palliative Care Organizations Web site at www.ohpco.org. On the same Web site you can find a workbook called "Conversations that Light the Way" to guide advance care planning. Although you do not need an attorney to execute advance directives, some people are more comfortable having an attorney help them.

The Office of the State Long-term Care Ombudsman can answer questions and supply more information about advance directives. Call toll-free 1-800-282-1206 for more information.

Advance directives are documents that will help Ohioans ensure that their preferences about emergency and long-term care will be honored if they are unable to decide for themselves. However, directives are just one part of a process that begins with a frank conversation with loved ones about a person's choices.