Many of us avoid advance care planning because it is hard to imagine ourselves in a vulnerable situation. While there may be an initial feeling of giving up control, developing an advanced care plan is actually about taking control.
The best first step is to talk with your family about your wishes and preferences for your care during a serious medical incident or end-of-life care. Completing an advance directive will help lessen the burden on families when it comes to difficult or controversial decisions.
By creating an advance care directive document and designating the person you would like to carry out your wishes, you make those decisions for yourself while you are able. This is not easy, but if you don’t create an advanced care plan, you leave the burden of decision-making to your family members or other caregivers.
What is an advance directive?
The New Hampshire advance directive consists of two parts: a durable power of attorney for healthcare and a living will. You do not need an attorney to complete a healthcare advance directive.
A durable power of attorney for healthcare (DPOAHC) is a document in which you name someone who will make medical decisions with your healthcare team on your behalf if you cannot. The person you choose becomes your "healthcare agent" or "proxy." A DPOAHC is not activated at the time of planning and only goes into effect when deemed necessary by a medical provider.
A living will serves as a written guide about life-sustaining treatments if you are permanently unconscious or terminally ill and unable to make decisions for yourself.
If you need assistance beyond making medical decisions, a general or financial power of attorney should be created.
Questions to think about and discuss
- Who do I trust to make decisions for me when I am unable?
- Who will honor my values and beliefs regarding medical decisions?
- Do I want to receive life-extending care even if it means causing pain for myself adding burden for my family?
- If I don’t want extraordinary measures taken to extend my life, how do I make that clear to my family and my doctor?
These are sensitive and emotional questions to consider. However, planning ahead and outlining your wishes allows you to continue to control your healthcare decisions. Clarify and document your end-of-life wishes with an advance care plan. Make copies of that plan and designate someone you love and trust to stand up for you when you no longer can.
Everyone should have an advance directive on file. When I work with patients, many people are unsure of what to include in a living will—the types of scenarios and options to consider, and their possible repercussions. Collaborative care nurses are all experienced with these conversations. We can guide your conversation to ensure your values guide your care.
Lauren Bianchi, resource specialist
Informing your family, friends, and your doctor?
Equally important to establishing an advance care plan is sharing it. Written advance directives are free, legal documents to be shared with family or friends and your healthcare providers, so they can understand and honor your wishes.
Planning early is essential in cases of dementia or other progressive neurological disorders
A complication of diseases such as dementia is that the person may lack or gradually lose the ability to think clearly. People can live with diseases such as dementia for years, so it can be hard to think of these as terminal diseases. Early planning is essential to ensure there is an advance care plan in place before the disease progresses and meaningful conversations camn occur
Frequently asked questions of Advance Care Planning
What is a Do Not Resuscitate (DNR) order?
A DNR is a medical order that specifies your wishes in the event that your heart stops. A DNR order expresses these wishes in your medical chart when you are in the hospital. It must be written in your medical chart by a physician or nurse practitioner. Whereas the advance directive is more of a guide to direct what decisions you want at the end of your life.
Will my healthcare provider know that I have an advance directive?
No, you must tell your healthcare provider. If you are a patient at Cheshire Medical Center, the Care Management team (603-354-6760 or 603-354-6573) can complete or talk you through the advance directives.
To whom should I give copies?
You should give copies of your advance directive to your:
- Healthcare providers
- Electronic medical records
- Family
- Person chosen to be your healthcare agent
You should also keep the original copy with your other important documents.
What if I change my mind?
You can change your advance directives at any time by destroying your current copy and filling out a new form. You should notify your healthcare provider and your DPOAHC (durable power of attorney for healthcare) to make sure they are aware of your changes and provide them with new updated copies.
Where can I learn more?
Beyond calling Cheshire’s Care Management team (603-354-6760 or 603-354-6573), you can find more information at the Honoring Care Decisions section of the Dartmouth Hitchcock Medical Center and Dartmouth Hitchcock Clinics website.