Advance Care Planning: How To Make Medical Decisions Before A Crisis

If an illness or accident left you unable to speak, would your family know your wishes?

Nobody wants to think about a serious accident or dying. But advance care planning gives you a voice, even if illness or injury leaves you unable to speak for yourself.

“Planning ahead helps your family and medical team understand your wishes before decisions become urgent,” said Xuan-Trang Day, MD, a hospice and palliative care medicine specialist. Dr. Day is an independent physician who chooses to practice at Franciscan Health Palliative Care Lafayette. “It can also spare your loved ones from having to guess what you would want during a crisis.”

Key Takeaways: Advance Directives

• A healthcare representative speaks for you if you cannot make or communicate medical decisions.
• A living will explains what care you want if you have a terminal condition and treatment would only prolong the dying process.
• A POST form gives more specific medical orders for people with serious or advanced illness.
• These documents work best when you review them over time, especially if your health changes.

When Should I Fill Out An Advance Directive?

Advance directives aren’t just for the seriously ill or dying. People who benefit from having advance directives include:

• Healthy adults
• People who are experiencing a new diagnosis
• Aging parents

What Are Advance Directive Forms?

Advance care planning can include several documents. The most common are a healthcare representative form and a living will. Some people with serious illness may also need a POST form. Each one serves a different purpose.

Find advance directive forms for your state.

What Is A Healthcare Representative?

A healthcare representative is the person you choose to make medical decisions for you if you cannot speak for yourself.

This situation does not happen only at the end of life. A healthcare representative may need to help if you are unconscious after an accident, in a coma, delirious, too confused to understand your choices or otherwise unable to communicate.

Depending on state law and the form you complete, a healthcare representative may help make decisions about where you receive care, which treatments you receive, who can access your medical information and certain decisions after death.

Because this person may face difficult decisions, choose someone who can listen, ask questions and follow your wishes. The person closest to you may not always be the best choice.

A spouse, adult child or close relative may feel too overwhelmed by grief or fear to carry out what you want.

“Don’t just fill out a form and put it away,” Dr. Day said. “Talk with the person you choose as your healthcare representative before you name them. Make sure they understand what matters to you and agree to speak for you.”

If you do not choose a healthcare representative, Indiana law gives doctors a process to determine who can make decisions for you. That person may be a court-appointed decision-maker, spouse, adult child, parent, sibling, other relative, close friend or another person allowed under state law.

Some states, including Indiana, require two witnesses or a notary public to sign the healthcare representative form. Terminology varies state to state as well. For example, Illinois uses the term “healthcare power of attorney” instead of “healthcare representative.”

What Is A Living Will?

A living will focuses on end-of-life care. It gives your medical providers guidance if you cannot speak for yourself and your physician determines that:

• You have an incurable illness, injury or disease
• Death will happen within a short time
• Life-prolonging treatment would only prolong the dying process

In that situation, a living will can tell your doctors that you do not want medical procedures that only prolong dying. It also lets you say whether you want artificially supplied nutrition and hydration, such as a feeding tube or intravenous (IV) fluids, at the end of life.

The living will form explains these choices. Take time to read it carefully before you sign it and make sure you understand when it applies.

“A living will does not mean you would refuse a ventilator, feeding tube or other treatment in every situation,” Dr. Day said. “For example, a person may need a ventilator during pneumonia or a feeding tube after a stroke and still have a chance to recover.”

Once you create a living will and choose a healthcare representative, make sure there’s a copy in your medical chart so your healthcare team knows your wishes and who to contact.

If you have questions about the living will, talk to your primary care provider. They can help you understand what the form means, when it takes effect and how it fits with your other advance directive documents.

What Is A POST Form?

A POST form, or Physician Orders for Scope of Treatment, gives first responders and other providers direct medical orders based on your current health and wishes.

A POST form is for people who have a serious, progressive illness, are medically frail or are at the end of life. It typically covers instructions for end-of-life situations, including:

• Whether to attempt resuscitation with CPR (cardiopulmonary resuscitation) if the heart stops
• What level of medical intervention to provide, ranging from comfort measures only to comprehensive life-sustaining treatments
• Whether to use feeding tubes

“Unlike a healthcare representative form or living will, you do not complete a POST form on your own,” Dr. Day said. “You complete it with a physician or nurse practitioner, who can walk you through each decision.”

POST forms vary from state to state. Talk with your provider to learn more.

Questions To Talk About With Your Doctor

Your doctor can help you understand what different treatments may mean for your health. These conversations can feel uncomfortable, but they help your family and care team honor your wishes.

Bring these questions to your next visit:

• What medical decisions should I think about now?
• Would CPR likely help me recover?
• What would it mean for me to go on a ventilator?
• Would artificial nutrition or hydration help in my situation?
• Should I consider a POST form?
• Who should have copies of my forms?

You should also tell your healthcare representative what matters most to you. Some people value living as long as possible. Others care most about comfort, staying at home or avoiding machines if recovery looks unlikely. Your loved ones need to know how you define quality of life.

Review Your Healthcare Wishes Over Time

Your wishes may change as your health changes. Review your healthcare representative form, living will and POST form if you receive a new diagnosis, your illness progresses or your goals change.

If you update your documents, give new copies to everyone who had the old version. That may include your healthcare representative, family members, doctors, hospital or long-term care facility.

Advance care planning can be empowering. When you make your wishes clear, you spare your loved ones the burden of making decisions for you. And it ensures that others know your wishes and have the information needed to carry them out.

Talk with your Franciscan Health provider about advance directives, including living wills, healthcare representative forms and whether a POST form may be right for you.