Advance Care Planning Communicates Health Decisions When You are Unable
Have you ever thought about who you would like to speak for you concerning health care decisions should you not be able
to speak for yourself?
This certainly is not a pleasant topic to consider, but it is one of the most important things to decide before a medical crisis happens that leaves you unable to make choices regarding your health care.
In Massachusetts, a legal form is available to designate a person to speak for you, if you are unable to make those decisions for yourself. This form is called a health care proxy, and it is available from most health care organizations, such as VNA Care Network & Hospice, and law offices. The proxy is a one-page form with easy directions. Just complete the proxy, sign it in front of two witnesses, and give copies to your designee (the person you ask to make health care decisions), family, and health care providers. The form is only put into use if your doctor determines you are unable to make health care decisions. You can cancel the form anytime you wish.
CHOOSING AN AGENT
The person you choose to speak for you is called the agent. Although not necessary, you can also appoint an alternate agent who would be called upon if your agent were unable or unwilling at the time. Choose someone you trust to make decisions based on your personal preferences and values. Your agent and alternate should agree to take on this role and be able to make decisions under stressful situations.
COMPLETING THE PROXY
When completing the health care proxy, it is important that you and the two required witnesses properly sign the form. Your agent and alternate agent can be anyone of your choosing, except an employee or administrator of a health care facility where you receive care unless that person is a relative by blood, marriage, or adoption. The witnesses cannot be the agent or the alternate agent. There is an optional place on the form to have the agent and alternate agent sign statements. Although it is not required, consider having them sign to assure they understand their role in your future health care.
MAKING YOUR WISHES KNOWN
A key step in this process is having a conversation with your agent and alternate agent about your personal preferences for health care should you not be able to communicate them for yourself. Tell them you do not want them to feel the burden of making decisions without knowing what you wish. This conversation is a gift to them!
Start this process by reflecting on what is important to you about care at the end of your life. Do you have certain cultural or religious beliefs which might influence your wishes? How do you feel about life-prolonging treatments, such as resuscitation or mechanical ventilation, if the expectation was that you would never be able to interact meaningfully with your family and friends again? How important do you view pain and symptom control in the management of your illness even if the medications make you drowsy?
You might want to discuss your thoughts with others who might help you sort through your values and options. Your physician or clergy member may be especially helpful.
Then talk with your chosen agent and others who are close to you. I recommend including family members in the conversation so everyone is clear about your choices. Don't assume they know your wishes.
Be clear about your wishes, giving examples of when you would want life-prolonging treatments started, when you would not want them started, and when you would want them withdrawn.
Consider putting your choices into writing. Currently, there is no legal form for this in Massachusetts, but written statements can be used as a guide by your agent and your health care providers in making decisions for you if you are unable. In all cases, be sure to communicate with everyone who might be involved in decisions for you, especially your agent(s) listed in the health care proxy and your physician.
RESOURCES
VNA Care Network & Hospice is part of the Central Massachusetts Partnership to Improve Care at the End of Life. Advance care planning materials are available on the organization's web site at www.betterending.org. Multicultural versions of the materials are available for the Spanish, Vietnamese, and African American communities. You can also download advance care planning materials at www.caringinfo.org.