Advance directives are part of the empowerment provided in the Patient’s Bill of Rights. We have choices regarding our care! Advance care planning is not a device for caregivers to limit the types of care patients receive. Rather, it is about empowering patients and their loved ones to make appropriate choices either for life-sustaining treatments or to forego them, based upon prior conversations together about treatment options.
There are several types of advance directives: The living will and durable power of attorney for healthcare are the most common, but some new varieties are popping up in various states to address care in other settings. Pre-hospital directives like physician orders for scope of treatment (POST) and physician orders for life-sustaining treatment (POLST) are fairly new for Idaho and Oregon. These are usually completed in consultation with your primary physician.
Advance directives are as much a process as they are a document. In order to efficiently communicate your wishes for healthcare in a stressful and potentially life-threatening situation, you need a directive, but you also need to impart your wishes more comprehensively with loved ones and care providers ahead of time so they understand the reasons for your choices. Your living will and/or durable power of attorney for healthcare can be the launching point for important conversations regarding your values, your fears, and your wishes for the last days, weeks, or even years of your life.
In 1996, a nonprofit coalition, Aging With Dignity, seized on the concept of finding the time and place to share such a conversation and composed a document called “Five Wishes.” Five Wishes communicates:
- Which person(s) you want to make healthcare decisions for you when you can't make them.
- The kind(s) of medical treatment(s) you want or don't want.
- How comfortable you want to be.
- How you want people to treat you.
- What you want your loved ones to know.
Most advance directives attempt to disclose at least the clinical implications of those five areas, but Five Wishes attempts to initiate a broader conversation—including, perhaps, discussions of a social, spiritual, financial or even philosophical nature. But, whatever form an advance directive takes, its purpose is to discover and communicate information about what matters most to people when their life and health are threatened.
Since whole industries are founded on our fears of growing older, gaining wrinkles and eventually dying, we are distracted from having frank and open discussions about the inevitable. The reality now is that most of us will die in a clinical setting. Wouldn’t it be better if we could make that experience a little less confusing and stressful for everyone?
Vice President of Physician Integration/Mission Services
Saint Alphonsus Medical Center — Ontario
351 SW 9th Street
Ontario, OR 97914