The deadly pandemic that shaped the past 1 1/2 years triggered new urgency to issues of advance healthcare planning for many families.
Fewer than half of severely or terminally ill patients have advance care directives – written documents outlining healthcare preferences should they be unable to make decisions themselves. Those instructions could include a living will, designation of a healthcare proxy (durable power of attorney), and preferences regarding organ and tissue donation.
This year, more than ever, advance care planning can be a balm. Establishing what kind of care you would want in critical situations and sharing your wishes with loved ones can be a great gift to those closest to you, offering them a measure of peace in a fraught time. The process can provide clarity and bonding:
- 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 way before then – during a routine visit to the doctor or, better yet, around the kitchen table.
The discussion can be general: Family members often make decisions based on the “spirit” of those conversations, much more than the specifics. But you may want to drill down as well. 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 – a request to forgo CPR if your heart has stopped - can also be part of a living will but doesn’t have to be. It depends on circumstances and preferences. 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. The point of advance care planning is to give people MORE control and to assist loved ones who might need to be making hard decisions in critical situations.
You don’t need to reinvent the wheel, there are resources online that can help guide these conversations, such as those at the New Jersey Department of Health. Holy Name Medical Center's Pastoral Care Department can also provide you with advance directive forms.
Designate a healthcare proxy – someone who knows your wishes and who can speak for you if you’re unable. Because unforeseen circumstances and scenarios arise, it’s best this person 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. Ask your potential proxies whether they are willing and able to honor your wishes.
Discuss your choices with your primary care physician. Doctors can be both empathetic and realistic in providing patients with a roadmap in these situations. Advance care planning should be an issue of wellness, just as certain screenings, like mammograms or colonoscopies, are prescribed based on age and circumstance. Generally, it is appropriate for someone over the age of 55, anyone with chronic serious illness or change in condition, or those about to have major surgery to plan in advance for healthcare needs.
Put your directives in writing/print. This formalizes the naming of your healthcare proxy and can outline your general and specific wishes. This paperwork can be added to your healthcare records so it is readily available in an emergency. Most hospitals and doctors’ offices have sample forms, which are readily found on the internet as well. These directives are not set in stone, they are meant to be a guide, and should be revisited periodically.
Advance care planning is NOT a euphemism for physician-assisted suicide or euthanasia. We would not recommend either at Holy Name.
Advance planning can reduce stress and uncertainty. It is a gift to your loved ones. The process of planning - having those thoughtful conversations about life and death with those close to you – can be enlightening and, ultimately, life-affirming.
James P. Morgan, MD, is Medical Director, Supportive Care Services, who specializes in palliative care, pain management and end-of-life care. Dr. Morgan is the co-founder and board president of Lamp for Haiti, a nonprofit organization that provides quality, cost-effective primary healthcare in Cite Soleil, Haiti, an area plagued with extreme poverty. He has been published in several medical journals and is licensed in New Jersey and New York. He is a member of the American College of Physicians.
To make an appointment for a palliative care consultation at Holy Name Medical Center, call