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The Truth About Advance Care Planning







By Susan Nelson, MD, LaPOST Coalition Chair

If you are in an accident or suffer an illness that leaves you unable to tell your loved ones and health care providers what kinds of medical treatments you do and do not want, who will speak for you?

Does that spokesperson know what you would want under those circumstances?

Have you taken the time to document your wishes?

Advance care planning is making decisions about the kind of care you do and do not want to receive if you become unable to speak for yourself. It involves not only telling your loved ones and physicians about your wishes, but also recording those wishes through the appropriate documents. These two very important steps can save your loved ones and doctors from the difficult position of having to guess what you might have wanted at the end of life.

On April 16, the Louisiana Physician Orders for Scope of Treatment (LaPOST) Coalition will join hundreds of other organizations across the nation in support of National Healthcare Decisions Day (NHDD), a national initiative to increase awareness about the value of advance care planning. In recognition of NHDD, the Coalition would like to debunk some of the common misconceptions about advance care planning:

Myth 1: Only the elderly and/or very ill need to worry about advance care planning.

The Truth: Advance care planning is a process that needs to be completed regardless of age or health status. Consider this hypothetical case: a seemingly healthy 30-year-old man – let’s call him Jack - collapses suddenly at home, losing oxygen flow to his brain for several minutes. He is left severely brain-damaged and completely dependent upon a feeding tube for nutrition. Jack’s wife claims that he would not have wished to be kept alive through such means, but his brothers and sisters argue to the contrary. Jack has no advance care planning documents in place to help his loved ones know his precise wishes, leaving them to ‘fight it out’ in court for years to come. This hypothetical scenario underlines the fragility of life – we cannot know when tragedy might strike. As human beings, we are all susceptible to the unexpected – events such as car accidents, sudden illness and the like – but we can be prepared to some degree through advance care planning, which empowers us with the ability to document our wishes for our loved ones and health care providers. Without that documentation, our loved ones may not know what we wanted at the end of life, or worse, they may not agree with each other about what our wishes would have been.

Myth 2: Advance directives, or living wills, are the same as ‘Do Not Resuscitate’ orders.

The Truth: Advance directives do not mean ‘Don’t treat me.’ They mean, ‘Treat me the way I want to be treated.’ We can use an advance directive to identify the kinds of treatments we do – and do not – want, and our loved ones can use this documentation to help our doctors develop a plan of care that matches our wishes. An advance directive can also be used to identify the person we want to speak for us if we cannot speak for ourselves. These legal documents take effect only when we lose the ability to make decisions for ourselves, and we can change or update them at any time.

Myth 3: I will have to hire an attorney to complete advance care planning documents.

The Truth: We can complete advance care planning documents without the assistance of an attorney. Here in Louisiana, we have three advance care planning documents available, and none of them require the services of a lawyer for completion. These documents include:

Advance directives, or living wills: We can complete these documents ourselves. In order for them to be valid, they need only be witnessed by two people. It does not have to be notarized.

Health care power of attorney: This document is used to formally authorize someone else to speak for us when/if we become unable to speak for ourselves. Our state has a specific order of who can make our health care decisions for us if these written instructions are not available, so to be certain that our spokesperson is the individual who we feel would best honor our wishes, it is important to have this document in place. Like an advance directive, we can complete this document ourselves. It does not need to be notarized, but does need to be witnessed by two people to become valid.

Louisiana Physician Orders for Scope of Treatment (LaPOST): The LaPOST document is more than an advance directive or a health care power of attorney. Designed specifically for patients with serious, advanced illnesses, it is a medical order that outlines our wishes and goals of care, and it can be used to translate an advance directive into a physician order. To become valid, the LaPOST document must be discussed by us and/or our health care representative and be signed by a physician. When completed, it must be honored by all health care professionals.

Myth 4: Once my advance care planning documents are completed, I can’t change my mind about my health care goals and wishes.

The Truth: Nothing is ever carved in stone when it comes to advance care planning. As our lives, circumstances and/or conditions change, so do our personal goals of care – for example, what we wanted when we were young and healthy may not be the same as what we want when we are elderly and/or seriously ill. We can change our advance care planning documents any time we wish.

Myth 5: Signing a health care power of attorney means I am giving away control of my health care.

The Truth: Signing a health care power of attorney means only that you are designating the person you would trust to make decisions about your care if and when you become unable to make those decisions for yourself. After signing the document, you still have the power to make your own health care decisions for as long as you are able to do so – treatment cannot be given to you or stopped over your objections. Your designated health care representative steps in only when your physician certifies that you lack the capacity to make your own decisions. It is also important to know that you can change your health care representative at any time you choose by simply completing a new health care power of attorney document.

As National Healthcare Decisions Day approaches, please take the time to have the conversation about your personal goals of care with your loved ones and your health care providers and then take the appropriate steps to document your health care wishes. These conversations, though often difficult, truly have the power to change lives. If you’d like to know more about advance care planning, please click here to download the LaPOST Coalition’s free ‘Conversations Change Lives’ toolkit, which includes a guidebook designed to help you identify and discuss your health care wishes.

Editor's Note: The LaPOST Coalition will kick off its third 'LaPOST Ready' campaign on National Healthcare Decisions Day, April 16, with a workshop featuring Dr. Nelson at Bayou Desiard Country Club, 3501 Forsythe, in Monroe, 11 a.m. - 1 p.m. To register to attend this free event, click here.
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