Time to talk about a tough topic - End of life wishes. It's hugely important to think about this topic and have meaningful discussions with loved ones about what you would want at the end of your life. However, there never seems to be a good time to have the conversation. Some people may not feel they know enough about end of life, the decisions to be made and the options available to them. It's very normal not to want to face your own mortality OR feel like an emotional burden for family members. Some cultures view discussions about death as taboo, making it challenging to broach the subject of advanced directives. However advanced directives, documented end of life wishes, can help to guide caregivers and medical providers in selecting care options that are consistent with your wishes for care in emergency and end of life situations.
What are the types of Advanced Directives?
Health Care Proxy forms - this is a legal document that names a trusted loved one to make medical decisions for you. This only becomes active if you are physically or mentally incapable of making decisions for yourself (ie. you are unconscious from an accident). This form can be filled out anywhere but must be witnessed by 2 people (other than those named in the document). Store the document in a safe place and provide a copy to the love one (optional) and your healthcare team. This form is best filled with the health care proxy's knowledge and with a conversation about what you would want in the event of a serious emergency (CPR, intubation, dialysis, long term life support). Example of form used in Maine: http://www.themha.org/policy-advocacy/Issues/End-of-Life-Care/advdirectivesform.aspx
MOLST/POLST forms - this is a legal document (available in many but not all states) that is filled with a trusted health care provider. It reviews the many lifesaving interventions (CPR, intubation, hospitalization, artificial nutrition/hydration, dialysis) and designates your wishes regarding each. The form is most helpful if you would prefer NOT to have one or more of these lifesaving interventions (ie. you DO NOT want CPR in case of emergency). These forms are filed with your health care provider, hospitals you might attend. It is very important to keep a copy posted on a fridge or close at hand in the event you call an ambulance service. These wishes (and medical orders) follow you across most healthcare institutions. Example of form used in Maine: https://mainehospicecouncil.org/images/The_Current_Maine_POLST_Form-do_not_copy.pdf
Advanced Directive/Living will - This is a comprehensive document that allows individuals to express their personal, emotional, and spiritual wishes regarding medical treatment and end-of-life care. It cover areas such as the person you want to make healthcare decisions for you, the kind of medical treatment you wish to receive or avoid, how comfortable you want to be, how you want people to treat you, and what you want your loved ones to know. Check out the 5 Wishes form for a very thoughtfully designed and well tested option - https://www.fivewishes.org/for-myself/
When filing advanced directives, it's crucial to communicate your medical treatment preferences clearly. Designate a trustworthy healthcare proxy who understands your values and is willing to make decisions on your behalf. Specify your stance on life-sustaining treatments, resuscitation, and other medical interventions in various scenarios. Discuss these preferences openly with loved ones and your designated proxy to ensure everyone is on the same page. Familiarize yourself with legal requirements in your state, ensuring your document is properly executed. Regularly review and update your advanced directives, considering changes in preferences, medical conditions, or relationships. Keep copies accessible to healthcare providers, and consider legal assistance to ensure compliance with local laws. By addressing these considerations, you can create a comprehensive and meaningful guide for your medical care and end-of-life decisions.
Your primary care provider is the perfect person to help facilitate meaningful conversation about advanced directives and health care proxy designation. Dont miss the opportunity at your next primary care visit to have this important conversation. If you are looking for a new primary care provider in the Bangor, ME area, check out Aging Grace House Calls.
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