What is an Advance Health Care Directive?
An advance health care directive (AHCD) is a legal document that can be used in California to convey decisions about end-of-life care ahead of time. It provides a way for you to communicate your wishes to family, friends, and health care professionals, in order to avoid confusion later on. An AHCD can serve one or both of these functions:
- Provide instructions about the kind of medical treatments or life-sustaining treatments you would want if you were seriously or terminally ill.
- Power of Attorney (PoA) for Health Care (appoint an agent). An agent is someone you appoint to make health care decisions for you should you become unconscious or unable to make medical decisions for yourself. You can also have your agent make decisions for you right away, even if you are still able to make your own decisions. You can also limit the authority of your agent. A PoA is generally more useful than only providing instructions. However, appointing an agent may not be the best choice if you don't have another person you trust to make health care decisions for you.
Who Should Have an Advance Directive?
Anyone over the age of 18 who wants to make their preferences about medical care known before being faced with a serious injury or illness should consider an advance directive. An advance directive not only ensures your wishes will be carried out, but it also spares your loved ones the stress of making decisions about your care while you are sick.
Having an advance directive can be especially important to those suffering from a terminal illness. Knowing your wishes will be respected can reduce suffering, increase peace of mind, and increase a sense of control over death.
In a recent Harvard Business Review article, it was reported that 70 percent of people say they want to die at home, but that 70 percent of people actually die in hospitals or nursing homes. This percentage is consistent with an AP-LifeGoesStrong poll conducted in spring 2011 that reported 64 percent of Americans born between 1946 and 1964 (and 70 percent of all US adults) said they did not have a health-care proxy, living will, or advance health care directive.
Completing a comprehensive advance directive and discussing your wishes with family and friends are critical components to ensuring every attempt is made to respect your end-of-life choices.
Sounds Difficult? Do I Need an Attorney to Help With This?
No. Completing an advance health care directive isn't difficult and an attorney is not necessary.
Where Do I Start?
There are many available advance health care directive resources. Based on our research, we recommend and endorse Aging With Dignity's Five Wishes. Five Wishes was introduced in 1997 and originally distributed with support from a grant by the Robert Wood Johnson Foundation, the nation's largest philanthropy devoted exclusively to health and health care.
Five Wishes meets California state legal requirements and is set apart from other available advance health directives because of its comprehensive approach to end-of-life preparation. In addition to covering the medical aspects of end-of-life care, Five Wishes addresses other important considerations, such as: how you would like to be kept comfortable, how you want people to treat you during the dying process, and information you might want your loves ones to know before you die. Discussing these areas will family and friends in advance can lead to a more positive experience or "good death," reduce confusion by family members, and give patient's a sense of control and peace.
If you are a member of FCA of Southern California, a complimentary copy of Five Wishes was made available to you. If you are not a member, Five Wishes can be obtained for $5.00 via the Aging with Dignity website.
What is a Do Not Resuscitate (DNR) Order?
A DNR is a type of advance directive. Specifically, it is a request not to have cardiopulmonary resuscitation (CPR) if your heart stops or if you stop breathing. Unless given other instructions, hospital staff will try to help all patients whose heart has stopped or who have stopped breathing. In California you must have a DNR form signed by your doctor in advance. Included here is a DNR form designed for use in prehospital settings (i.e. in a patient's home, in a long-term care facility, during transport to or from a health care facility, and in other locations outside acute care hospitals). Hospitals are encouraged to honor the form when a patient is transported to an emergency room.
The prehospital DNR form was developed by the California Emergency Medical Services Authority, in cooperation with the California Medical Association and emergency medical services providers. The prehospital DNR form must be signed by the patient or by the patient's legally recognized health care decision maker and the patient's physician.
Be advised that a completed prehospital DNR form may not be honored in other states or jurisdictions. Also, the prehospital DNR form does not replace other DNR orders that may be required pursuant to a health care facility's own policies and procedures governing resuscitation attempts by facility personnel.
Consider watching Peter Saul's TED Talk titled "Dying in the 21st Century"
Dr. Peter Saul on Dying in the 21st Century