3. PLANNING STEPS
Modern medicine may have made dying harder, but it has also given us the gift
of time--the time to prepare, the time to heal family wounds, the time to
bring psychological and spiritual closure. If we can take advantage of it, it
has given us something unique in history: the time to tie up loose ends and
orchestrate a death that is good.
-from The Good Death by Marilyn Webb
(A) ADVANCE CARE PLANNING
(B) EXPLORING THE ISSUES
(C) DISCUSSING YOUR DECISIONS
(D) APPOINTING A HEALTH CARE AGENT
(E) COMPLETING THE FORMS
(A) ADVANCE CARE PLANNING
Making decisions for future healthcare needs may seem like an impossible
task. How can you plan for all the possibilities?
Advance Care Planning can be accomplished by following these steps:
1. Exploring the Issues
2. Discussing Your Decisions
3. Appointing a Health Care Agent
4. Completing the Forms
5. Using an Advance Directive
(B) EXPLORING THE ISSUES
Start by thinking about situations where:
· You become unexpectedly incapable of making your own decisions.
· It is clear you will have little or no recovery.
· Your injury or loss of function is significant.
These types of situations may arise because of an injury to the brain from an
accident, a stroke, or a slowly progressive disease like Alzheimer's.
Many family members have told us that vague statements like I don't want to
be a vegetable or I don't want to be hooked up to machines the rest of my
life just are not adequate to guide the decision making of your loved ones
during these very stressful situations.
Consider your personal values about quality of life. What makes being alive
meaningful for you? You will need to describe the circumstances under which
your goals for medical care would change from prolonging your life to being
allowed to die. In some situations certain treatments may not make sense
because they will not help, but other treatments will be of important
benefit. Some people want everything possible done to delay death. Others
don't want dying to be prolonged. Where would you draw the line?
Consider these questions:
· What do you value most in life?
· What concerns you most about death and dying?
· What type of spiritual support would comfort you near the end?
· How does cost influence your decisions about medical care?
· What role does your religion play in how you live your life? Are you
familiar with your religion's position on end of life concerns?
There are many myths and misconceptions about religious requirements at the
end of life. Munson Medical Center's Palliative Care dept has End of Life
position papers from most major religions. If your faith is important to you,
we encourage you to find out what it says about this important decision.
(C) DISCUSSING YOUR DECISIONS
It is important to have these conversations now.
Make arrangements to discuss your decisions with the people you trust. Too
often these issues aren't addressed until you are admitted to a hospital with
a life-threatening situation. In that event, you may not have the capacity to
make your own decisions, and the choices will fall on the shoulders of your
distressed family members in the waiting room. This will leave them playing a
guessing game, and frequently, feeling guilty.
It is always difficult for people to accept that a loved one is dying;
especially since doctors usually can't predict how much time a patient has to
live. The subject of dying is often avoided for fear that it means "giving
up". Yet, when family members are helped to face what lies ahead, they are
better able to seek the care best suited for their loved one. Many questions
need to be addressed to help understand the patient's medical condition and
what comes next:
· Is it still possible to cure her/his disease or illness?
· If no cure is possible, what are the chances she can at least improve?
· Given her/his current condition, what do you expect in the next few weeks?
In the next few months?
· Are other medical problems likely to arise?
· What are the treatment options?
(D) APPOINTING A HEALTH CARE AGENT
Appoint someone to make Health Care Decisions for you.
Name the person who will be your Health Care Proxy. If both your attending
physician and another health care professional finds that you can no longer
make health care choices, this person will speak for you. Many people choose
a close family member, but you are free to pick anyone you think could best
represent you. The person you appoint should have all of the following
qualifications:
· 18 years of age or older.
· Knows you very well and cares for you.
· Trustworthy, and likely to be nearby in the event of an emergency.
· Willing to accept this responsibility.
· Willing to follow the values and instructions you have discussed.
· Willing to stand up for you and insist your wishes are honored.
· Able to make complex, difficult decisions during stressful situations.
The person you choose should not be your health care provider, the owner or
operator of a health or residential care facility serving you, or an employee
of your health care provider.
Examples of decisions you may expect your health care proxy to make for you
are:
· Make choices for you about medical care services like tests and surgery.
· Arrange for your admission to a hospital, hospice, or nursing home.
· Make the decision to request, take away or not give medical treatments,
including tube feeding and hydration, and any other treatments to keep me
alive.
· Sign for release of your medical records and personal files.
· Take any action needed to carry out your wishes.
· Apply for Medicare, Medicaid, or other programs of insurance benefits for
me.
(E) COMPLETING THE FORMS
Choose a Document:
Choose an Advance Medical Directive that helps you describe not only your
medical wishes, but also your personal, emotional and spiritual wishes. You
have a legal and moral right to decide what kind of medical treatment your
want or don't want when your are seriously ill and your death is imminent. In
Michigan, you do this by choosing a proxy, a person to make health care
decisions for you when you are no longer able to speak or think clearly.
Be specific when describing your wishes. Some examples are:
· I do not want to be in pain. I want my health care providers to give me
enough medication to relieve my pain, even if it means that I will sleep more
than usual.
· I want to die in my home.
· I want to be bathed and kept clean.
· I want to have my favorite music played often, even if I am seemingly
unresponsive.
· I wish to have daily prayers said at my bedside.
· I want friends and relatives to visit, hold my hand, and talk to me about
the daily lives of their families.
Five Wishes ( www.agingwithdignity.org ) is an excellent advance directive
that can help you describe your wishes. It is gaining in popularity across
the country and is accepted in many different states. It is easy to use and
understand. It does not use clinical or legal language. It allows people to
discuss comfort, dignity, and forgiveness, not just medical concerns. Clearly
spelling out even the smallest details that are important to you will give
your surviving loved ones a sense of relief when they can help to fulfill
your wishes.
Munson Medical Center has copies of Five Wishes. Other types of advance
directives can be found at the following links:
http://www.choices.org/ad.htm
http://www.abanet.org/elderly/sources.html
http://www.ama-assn.org/public/booklets/livgwill.htm
Managing your Form
Copies of your form need to go to:
--The person you have chosen to make decisions for you.
--Your physician.
--The hospital you most likely would be admitted to.
Electronic Retrieval Systems:
Many people are using the internet to store and retrieve their advance
directives. You may want to investigate this further by visiting the
following websites:
http://www.giftsdirectives.com/
http://www.mednotice.com/
http://www.uslivingwillregistry.com/info-english.html