Advance Care Planning: Care Instructions

Overview

It can be hard to live with an illness that cannot be cured. But if your health is getting worse, you may want to make decisions about end-of-life care. Planning for the end of your life does not mean that you are giving up. It is a way to make sure that your wishes are met. Clearly stating your wishes can make it easier for your loved ones. Making plans while you are still able may also ease your mind and make your final days less stressful and more meaningful.

What can you do to plan for the end of life?

• You can bring these issues up with your doctor. You do not need to wait until your doctor starts the conversation. You might start with, "What makes life worth living for me is. . ." And then follow it with, "I would not be willing to live with . . ." When you complete this sentence it helps your doctor understand your wishes.
• Talk openly and honestly with your doctor. This is the best way to understand the decisions you will need to make as your health changes. Know that you can always change your mind.
• Ask your doctor about commonly used life-support measures. These include tube feedings, breathing machines, and fluids given through a vein (I.V.). Understanding these treatments will help you decide whether you want them.
• You may choose to have these life-supporting treatments for a limited time. This allows a trial period to see whether they will help you. You may also decide that you want your doctor to take only certain measures to keep you alive. It may help to think about the big picture, like what makes life worth living for you or what your values and goals are.
• Talk to your doctor about how long you are likely to live. Your doctor may be able to give you an idea of what usually happens with your specific illness.
• Think about preparing papers that state your wishes. These papers are called advance directives. If you do this early and review them often, there will not be any confusion about what you want. You can change your instructions at any time.

Which papers should you prepare?

Advance directives are legal papers that tell doctors how you want to be cared for at the end of your life. You do not need a lawyer to write these papers. Ask your doctor or your state health department for information on how to write your advance directives. They may have the forms for each of these types of papers. Make sure your doctor has a copy of these on file, and give a copy to a family member or close friend.

• Consider a do-not-resuscitate order (DNR). This order asks that no extra treatments be done if your heart stops or you stop breathing. Extra treatments may include cardiopulmonary resuscitation (CPR), electrical shock to restart your heart, or a machine to breathe for you. If you decide to have a DNR order, ask your doctor to explain and write it. Place the order in your home where everyone can easily see it.
• Consider a living will. A living will explains your wishes about life support and other treatments at the end of your life if you become unable to speak for yourself. Living wills tell doctors to use or not use treatments that would keep you alive. You must have one or two witnesses or a notary present when you sign this form. A living will may be called something else in your state.
• Consider a medical power of attorney. This form allows you to name a person to make decisions about your care if you are not able to. Most people ask a close friend or family member. Talk to this person about the kinds of treatments you want and those that you do not want. Make sure this person understands your wishes. A medical power of attorney may be called something else in your state.

These legal papers are simple to change. Tell your doctor what you want to change, and ask him or her to make a note in your medical file. Give your family updated copies of the papers.