The unpredictability of life makes planning for the uncertain a crucial task.
Creating provisions for health-related events is especially important when it comes to circumstances beyond our control. Whether sudden or progressive, young or old, major illness such as dementia, cancer, debilitating heart failure, COPD, coma, major events like accidental injuries or death can happen to you or a loved one at any time.
It’s important to prepare as early as we can for moments when we might not be able to make our wishes known. As healthcare providers, we want a patient’s autonomy to be respected in their most vulnerable state, and alleviate some of the burdens on loved ones who might to make decisions for you if you’re unable. Here some options to think about and discuss with your loved ones and your healthcare provider:
- Advance care directives are legal written documents that guide your healthcare providers and caregivers, sort of like a blueprint, regarding your preferences for medical care if you are unable to make decisions for yourself due to physical or mental incapacitation. The two most common types are a healthcare proxy form and a living will.
- A healthcare proxy, also referred to as a medical power of attorney or healthcare agent, is someone you choose to make any necessary healthcare decisions on your behalf if you are incapacitated. This person must be someone you trust to make decisions on your behalf, who is aligned with your wishes, as they would be able to make decisions such as whether to proceed with certain medical treatments or procedures you may need, including antibiotics, life support, CPR, intubation, tube feeding, dialysis, surgery or organ donation. With a healthcare proxy, you can give specific instructions and set limits to how this person is able to make decisions on your behalf. It is important to have a conversation with your designated healthcare proxy (proxies, if more than one person), so everyone is on the same page and your wishes will be respected and documented properly. Your proxy cannot make healthcare decisions for you if you are awake and mentally competent to make your own decisions. They also cannot make financial decisions or decide other legal matters on your behalf, only medical. Note: Your healthcare provider can assist you with a understanding a healthcare proxy.
- A living will documents your wishes in case of emergency and/or end of life care. Similar to a healthcare proxy, you dictate specific treatments such as CPR, life support, antibiotics and other possible interventions you’d want to have. How much, or how little, is done in terms of your care is based on that document. Unlike a healthcare proxy, there is no individual involved who makes those decisions for you. The wishes outlined in the living will are the decisions that will stand.
- Medical Orders for Life Sustaining Treatment (MOLST) forms dictate your current healthcare management based on your current health status, prognosis, goals and preferences for treatment. It is a form you complete along with your healthcare provider and is usually carried with you in all healthcare settings, such as hospitals and nursing homes, and helps your healthcare team know your wishes regarding CPR or other life sustaining treatments – like intubation. You must have a thorough conversation or series of conversations with your healthcare provider, and if you have a healthcare proxy they must also be present, while you make those decisions. It is signed by your healthcare provider after they provide explanations to all involved so everyone has proper understanding and can make an informed decision.
- Both hospice and palliative care are designed to improve quality of life for the patient and provide emotional and practical support to their caregivers and loved ones, and there are some similarities, but also some stark differences, between the two.
- Palliative care can start for any serious illness like heart failure, COPD, dementia, Parkinson’s disease or cancer while you still seek curative or life-prolonging treatments. In other words, you don’t have to stop treatment to have palliative care. It has many benefits such as improving quality of life, coordination of care among specialists, spiritual support and guidance for you and families.
- Hospice care is used when you no longer wish to receive life-prolonging care or it is no longer beneficial, typically for an individual who has been given six months or less to live based on the prognosis or progression of an illness. It helps support the ill-person and their loved ones at the end of life. Hospice care can be provided in your home, nursing facilities or specialized hospice facilities and focuses on comfort care only.
Whether you or loved ones are healthy or have many health challenges, it is never too early to engage in medical conversations and take those important steps to make sure your wishes will be honored.
And, as life circumstances change, you can change your healthcare proxy or living will or revisit your MOLST form and make changes with your healthcare provider. Protect your autonomy, and the autonomy of your loved ones, by discussing these options with your healthcare provider to prepare for the uncertain as soon as you can.
H3: Author
Wheveline Orvil, MD, transitional year resident
