People do not like discussing the idea of planning for end-of-life medical care. However, everyone should prepare for future illnesses and accidents, even if today seems too soon. If healthcare decisions are not in place, a stranger might have to make them for an unresponsive patient. Moreover, if medical personnel can reach a patient’s family, strangers might decide on the treatment method.
The United States has recognized National Healthcare Decisions Day (NHDD) yearly on April 16th since 2008. Nathan Kottkemp founded the day to encourage conversations that motivate people to think about their emergency and end-of-life healthcare wishes. In addition, every family member should have a care plan, including infants. Unfortunately, most people wait to make their wishes known until a medical emergency or their cognitive ability is compromised.
Despite a national movement to address the importance of making end-of-life plans, “studies and surveys generally find that many of us have not yet taken the needed steps to make our wishes known,” explained Dr. Leslie Kernisan. For example, a 2012 study revealed that only 38% of Medicare beneficiaries reported they completed advance care planning.
Emergencies are not fun to think about, but it is worse to encounter one without preparing ahead of time is worse. Imagine a parent’s extreme feelings after a vehicle hit their child. After rushing to the emergency room, parents or guardians must manage their feelings to let the doctor know how they want their child treated. The situation could be worse: Imagine a parent’s heart-wrenching anxiety of telling a medical team how to handle their child’s end-of-life care.
Evidence shows that those who prepare for life’s surprises handle crises better than those who do not. Of additional importance are the results of a study: Nearly one in three people incorrectly guessed a loved one’s end-of-life decisions.
Knowing this begs an answer to this question: Why would anyone delay doing something today that will reduce future extreme stress typically associated with emergencies involving loved ones, especially children?
Advance Care Planning for End-of-Life Medical Treatment
As difficult as it may seem, advance care planning is straightforward. Making a plan involves discussing and preparing for future medical care decisions if a loved one becomes seriously ill or cannot communicate their wishes.
Moreover, planning for end-of-life medical care may help loved ones mourn more easily and feel less burden, guilt, and depression.
Remember that the document creator can usually revise or cancel personal medical directives anytime. Therefore, these are living documents that a person should review at least once a year. Additionally, a person should update the records when major updates, such as moving out of state, retiring, or a significant change in health.
There are two common advance directives for health care every person 18 years and older should complete and keep up to date; living will and durable power of attorney for healthcare.
Since many states’ forms differ, the American Bar Association published a pdf with links to assist those needing state-specific advance directive forms.
Living Will
Individuals create living wills to advise doctors about medical care if they cannot. Doctors only use the living will at the end of a person’s life if they are terminally ill or permanently unconscious.
The document details the person’s preference for receiving or declining medical or life-sustaining treatments if the person becomes terminally ill or injured and unable to convey those decisions for themselves.
Durable Power of Attorney for Healthcare
People sometimes call durable power of attorney for healthcare a medical power of attorney. It is a legal document naming a person to be a prox or agent who will make legal decisions. However, the patient’s doctor must certify that they cannot make their own medical decisions before medical personnel can apply the directions outlined in the durable power of attorney.
Medical Forms
People might want to advise their doctors about a single medical issue or something not covered in their advance directives. In these situations, patients or their families can talk with the doctor about creating specific orders such as a DNR, DNI, DNH, out-of-hospital DNR, and POLST or MOLST.
- Do not resuscitate (DNR) orders become part of a patient’s medical chart. It informs the hospital or nursing facility medical staff that patients do not want CPR or other life-support efforts if their heart or breathing stops. Sometimes medical providers call the form “a do not attempt resuscitation (DNR) order or an allow natural death (AND) order.”
Notably, even if a person’s living will states CPR is unwanted, including a DNR as part of the patient’s medical file during a hospital visit is helpful. To avoid confusion, medical staff should post a DNR next to a patient’s bed to avoid confusion since the staff will attempt to restore the patient’s breathing and heartbeat. - Do not intubate (DNI) orders are similar to the DNR. However, people use a DNI form to tell nursing facilities or hospital staff that the patient does not want to be on a ventilator.
- Do not hospitalize (DNH) is a directive patients create to inform long-term care providers and nursing facility staff they do not want to be hospitalized for end-of-life treatment.
- Out-of-hospital DNR order is created by a patient or their proxy to advise emergency medical personnel not to restore a person’s heartbeat or breathing if they are not in the hospital.
- Physician orders for life-sustaining treatment (POLST) and medical orders for life-sustaining treatment (MOLST) forms are used by individuals to give medical staff instructions for emergency treatment instructions. A POLST or MOLST serves as a medical order in addition to the patient’s advance directive. Normally one of these forms is created when a person nears the end of their life or is critically ill and understands the specific decisions that medical personnel might need to make for the patient. Sometimes these forms are called portable medical orders or physician orders for scope of treatment (POST).
Hospital admissions and medical staff can direct someone to where these forms can be found. Remember, creating end-of-life planning or advance directives to cover emergency medical care permissions, and directions is never too early.
Written by Cathy Milne-Ware
Sources:
Better Health While Aging: 5 Questions to Ask Yourself on National Healthcare Decisions Day; by Leslie Kernisan, MD MPH
Institute for Healthcare Improvement: National Healthcare Decisions Day (NHDD) — April 16
National Institue on Aging: Making Decisions for Someone at the End of Life (English)
National Institute on Aging: Entender las decisiones sobre la atención médica al final de la vida (Español)
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