ADVANCE CARE PLANNING

 With advance care planning, "Clinical care is shaped by a patient's preferences when the patient is unable to participate in decision making" (Teno 1994). A written and legal document called an advance directive (either a living will or durable power of attorney) is one outcome of good advance care planning. Patients have the right to accept or reject medical treatments including withdrawing or withholding life support. Good advance care planning should result in patients understanding their prognoses and likely outcomes of care, and be provided with the opportunity to reflect and formulate on important goals and plans.

  It is extremely important that advance care planning decisions are reviewed with the patient's physician and copies provided to any health care institution that a patient may be admitted to for care. Likewise, it is imperative that advance care planning decisions be shared with the individual's family. Over the course of an illness, there is usually a transition in the goals of care from the focus of extending and preserving life to that of maximizing the patient's comfort. The timing of this transition, and the degree to which it is based on the informed preferences of the patient (advance care planning), are important outcome variables in end of life care for the patient.

  Laws about advance directives vary from state to state. Individuals should be aware of the guidelines of their state laws regarding the scope and technical requirements that apply to advance directives. Living wills and durable power of attorneys for health care are legal in most states. Even if the law in your state does not officially recognize them, they can still guide your loved ones and doctor if you are unable to make decisions about your medical care.

DEFINITIONS

1. An Advance Directive is a document in which a person gives advance directions about medical care, and/or designates who should make medical decisions for the person if he or she should lose decision-making capacity. A good advance directive describes the kind of treatment you would want to receive for different levels of illness. For example, the directives would describe what kind of care you would want if you have a critical illness, a terminal illness or permanent unconsciousness. Advance Directives usually tell your doctor that you don't want certain kinds of treatment when you are this ill. However, they can also indicate that you want a certain treatment, no matter how ill you are. There are two common types of advance directives: a Living Will and Durable Power of Attorney for Health Care.

2. A Living Will is a written statement prepared by an individual with decision-making capacity directing what forms of medical treatment the individual wished to receive or forego should he or she lose decision-making capacity. A living will only comes into effect when you are terminally ill. Being terminally ill generally means that you have less than six months to live.

3. A Durable Power of Attorney for Health Care (DPOA-HC) is an individual's written designation of another person to make decisions about his or her medical treatment if the individual should lose decision-making capacity. Losing decision-making capacity is indicated when an individual is unconscious or unable to make medical decisions.

RESOURCES