Advance Care Planning: Your Decisions Matter Expressing wishes for end of life care is important to people of all ages from all walks of life

Advance Care Planning: Your Decisions Matter

Expressing wishes for end of life care is important to people of all ages from all walks of life.

Your Decisions Matter

Images of Death

We often imagine that we will die suddenly… but most people actually experience a slow, progressive loss of body function.


We Anticipate and Plan for Important Life Events

The process of dying is as natural as the process of being born.Pregnancy is a developmental state that prepares us for birth, dying is a developmental phase of “undoing” or “unwinding”.•Both of these phases take time•Both have observable changes in the body


Do you know what healthcare treatments you would and would not want if you could not speak for yourself?

Do other people know what your wishes are?


Our Objectives for Today

1. Discover the value of advance care planning 2. Learn how to talk about your future healthcare

decisions3. Understand how to document your healthcare

decisions using health care directives4. Identify with whom to communicate your

decisions


Advance Care PlanningInvolves:Learning about treatment options

Thinking about your values

Decide what you want and do not want

Choosing an Agent and talking about your decisions

Documenting your wishes

Your Rights


You have a right to make your own health care decisions as long as you have the ability to:

Understand and appreciate the nature and consequences of a health care decisionCommunicate a health care decisionUnderstand your condition

Karen Quinlan

http://upload.wikimedia.org/wikipedia/en/d/d7/KarenAnnQuinlan.jpg


Patient Self-Determination Act

You have a right to make your own health care decisions as long as you have the ability to:

Understand and appreciate the nature and consequences of a health care decision

Communicate a health care decision

Understand your condition

Patient Self Determination Act


“If I become terminally ill, I ask that I be told of this so I can prepare myself for death. I would like assistance with contacting my priest/pastor who will care for my spiritual needs.”

Death does not need to be resisted by every means.

“

You can refuse medical treatment that only prolongs imminent death.


Why Plan Ahead?

Unable to speak for yourself

Sudden illness or accidents

Leave a guide for others

Peace of mind for loved ones

Our lives can change in an instant…most of us are not able to predict when we might near death.


Questions to DiscussWhat do you want and not want at the end of life? Who should speak for you?What are your concerns?What gives your life the most meaning?What one thing do you want to be sure your doctors, family and friends know about your wishes?

Take time to reflect on these questions.


What are your wishes for physical, emotional or

spiritual comfort? Be kept comfortable and minimize pain?

Even if the medication impairs your thinking?

Even if the medication might alter your breathing and shorten your life?

Preserve life regardless of your physical or mental health?

Make health care decisions with consideration for your religion and beliefs?


What are your wishes related to life support?

If there is no reasonable change to regain your life physically or mentally?If you have physical limitations but can relate to family and friends?If you cannot relate to family and friends?If you have brain damage or are in a coma?If you have confusion or dementia that will not improve?


What are your wishes about how to live?

Want to be healthy enough to care for yourself?Want to remain in your own home?Want to live without being dependent upon medical treatments to be kept alive?Want to die naturally without lingering?Want health care even if it exhausts personal finances?


Talking About Your DecisionsValuable opportunity to reflect on what’s important with loved onesDiscussion needs to happen before a crisisCan provide comfort to your loved onesIs up to YOU to initiate

Meal time can be a good time to begin this conversation with your family members.


Decisions that your loved ones may have to make

CPR-Cardiopulmonary ResuscitationArtificial Breathing - VentilatorLife Saving MedicationsArtificial Food and Fluids (feeding tubes)Kidney DialysisTissue and Organ Donation

It’s less stressful to think about these treatments ahead of time.


Documenting Your Decisions

Health care directives document healthcare decisions at the end of life-it is a tool to help you think through and communicate your choices

Gives instructions about aspects of health careDesignate an agent to speak on your behalf when you are unable to speak for yourselfCan give instructions about other end-of-life wishes


Healthcare Power of Attorney

Document who makes medical decisions about your healthcareAuthorized to speak ONLY if you can’tMay also be called a:

"healthcare proxy or agent" “healthcare surrogate” "durable power of attorney for healthcare"


Your Healthcare Agent

Is someone who:You trustKnows you wellWill advocate in your behalfWill honor your wishes

Can be anyone over the age of 18Can be a family member, loved one or close friend


Living WillStates what you want and do not want for medical treatments at the end of life but does not identify someone to speak on your behalfMay also be called:

Directive to physiciansHealthcare declarationMedical directive

A Health Care Directive may permityou to do the following…

The Five Wishes document is available in 26 languages and in Braille.

• State your health goals and values• State preferences about making an anatomical gift

(organ donation)• Give instructions about where you want to die• State funeral arrangement preferences


Important to Know This is not just an issue for the aging Your health care directive should reflect your

wishes—only you can write your directive Lawyers are not needed Make sure your documents are legally valid in the

state where you reside-a notary or two witnesses must sign in ND & MN

A Health Care Directive does not expire and can be updated as needed—review it periodically

What to do with the written document


Give a copy to:

• Your Healthcare Agent• Primary provider (doctor)• Health Care Facility• Close family members• Others to consider:

– Faith community leader– Attorney

Keep a copy:

• Where you live• To bring with you if you

travel– Most states have reciprocity

statutes that recognize health care directives completed in other states

• For another facility if care is transferred


When an Health Care Directive is present, a Health Care Provider must:

Read the documentValidate the contentRespect and follow patient choicesIf unable to follow or carry out, must provide for transfer of care to another provider/facility


Key Points about Writing an Health Care Directive:

Include your loved ones in the decision—this is a gift you can give to your family and loved onesVisit with your primary care provider at your annual visitTalk with your faith community leader or a parish nurseDon’t wait until you are sick to complete this important document


Key Points about Writing an Health Care Directive:

Make sure it is properly witnessed Make copies for family or health care agentKnow that it can be changed or revoked at any time by youMust be in writing


What happens if you don’t have an health care directive?

State law determines who makes decisions when you cannot speak for yourself

In North Dakota the order is:Court-appointed guardian or custodian if there is oneSpouseChildrenParentsAdult brothers and sistersGrandparentsAdult grandchildrenAn adult friend or close relative


Your decisions matter…Your decisions matter…you have choicesyou have choices

Talk to your loved ones“I learned today that my decisions matter. I want to take this

opportunity to talk with you about my decisions for healthcare if I am ever in a situation where I can no longer speak for myself.”

Get information that will help you make the best decisions for you then develop a written health care directiveEncourage others to document their wishes and talk with their loved ones too


Resources That Can Help

Sanford Health

Patient Representative or the House Administrator after 4:30 p.m. or on weekends

Sanford Health website at www.sanfordhealth.org Health care Directives Information and forms can be found at

Caring Connections at www.caringinfo.org/stateaddownload/National Healthcare Decisions Day at www.nationalhealthcaredecisionsday.org ND Department of Human Services at http://www.nd.gov/dhs/

MN Department of Health at http://www.health.state.mn.us/

http://www.sanfordhealth.org/

http://www.caringinfo.org/stateaddownload/



http://www.nationalhealthcaredecisionsday.org/

http://www.nd.gov/dhs/

http://www.health.state.mn.us/


The future depends on what we do in the

present. –Mahatma Gandhi

The art of living well and the art of dying well are one. Epicarus

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Advance Care Planning: Your Decisions Matter Expressing wishes for end of life care is important to people of all ages from all walks of life