The COVID-19 pandemic of the past 18 months focused attention on the benefits of planning healthcare in advance, when we are well rather than when ill. Even if you haven’t been directly affected by the virus, you may have thought about what healthcare decisions you would make or would want made for you if you were incapacitated.
“Advance care planning can be a balm,” says James P. Morgan, MD, medical director of Holy Name’s Supportive Care Services. “Establishing what kind of care you would want in critical situations and sharing your wishes with loved ones can be a great gift, offering them a measure of peace.”
Fewer than half of severely or terminally ill patients have advance care directives – written documents outlining healthcare preferences should they be unable to make decision themselves. These instructions could include a living will, designation of a healthcare proxy (durable power of attorney), and preferences regarding organ and tissue donation.
Planning for serious illness or injury, using an advance directive, should be done ideally when people are healthy, fully in control of their mental faculties. To plan your healthcare decisions, Dr. Morgan suggests the following:
• Start a conversation about your wishes; the earlier, the better, and revisit it every year or so, particularly as you age or if health issues arise. These discussions with loved ones and healthcare providers often start during crisis, in the hospital. But they are best begun during a routine visit to the doctor or, better yet, around the kitchen table.
The discussion can be general: Under what circumstance would you want to be on a ventilator, fed with a tube, or revived by CPR? What kind of palliative or comfort care would you want to relieve suffering and manage pain?
A do-not-resuscitate (DNR) order – to forgo CPR if your heart has stopped – can also be part of a living will but doesn’t have to be. Many people don’t make an advance directive because they incorrectly assume a DNR is part of it and will limit choices for care. The opposite is true. Advance care planning gives people MORE control and assists loved ones who might have to make hard decisions.
• Designate a healthcare proxy – someone who knows your wishes, can speak for you if you’re unable, and is familiar with your overall worldview, your practical and spiritual framework, and your thoughts about living and dying. It is also good to have a second proxy who can support that person in decision-making.
• Discuss your choices with your primary care physician. Doctors can be both empathetic and realistic in providing patients with a roadmap. Advance care planning should be an issue of wellness, just as certain screenings, like mammograms or colonoscopies, are prescribed based on age and circumstance.
• Put your directives in writing/print. This formalizes the naming of your healthcare proxy and can outline your general and specific wishes. Most hospitals and doctors’ offices have sample forms, which can be added to your records so they are available in an emergency. These directives are meant to be a guide and should be revisited periodically.
“Advance care planning is NOT a euphemism for physician-assisted suicide or euthanasia,” says Dr. Morgan. “We would not recommend either at Holy Name. Instead, advance care planning can reduce stress and uncertainty. The process can be enlightening and, ultimately, life-affirming.”
James P. Morgan, MD, is a board-certified internist who specializes in palliative care, pain management, and end-of-life care. He is the medical director of Holy Name’s Supportive Care Services, comprising palliative care and hospice care.