Although it is a subject many individuals choose to avoid, it is extremely
important to discuss your wishes for the end of life with your family.
Changes in medical technology have made it possible to keep a person alive
well beyond the point where their lives may have meaning and quality to
them. Patients who do not communicate their wishes regarding their medical
choices can be kept alive by cardiopulmonary resuscitation (CPR), ventilators,
dialysis, artificial feeding, and other methods. Without these prior conversations
and supporting documents, medical providers must continue treating individuals
aggressively to prolong life. Often, the extremely difficult decision
to limit life prolonging treatment falls upon family members who may have
different ideas about what the patient would want. Families often decide
to keep a loved one alive as long as they can to avoid the second-guessing
or guilt that may come with choosing less aggressive, more comfort focused care.
“You can minimize this difficult process by being proactive and discussing
your wishes for end of life with your family,” says Laura Sigmon
Parker, MSN, FNP-BC with CVMC Palliative Medicine. “This not only
involves filling out advance directives such as a living will, MOST form
and healthcare power of attorney; it should be paired with an ongoing
discussion to clearly explain your wishes in the event of a life-threatening
illness or accident. This may be the kindest, most useful gift you ever
give to your loved ones.”
Preparedness is key, and the sooner an individual discusses their end of
life wishes with their family, the better because we never know when a
life-threatening event will occur. Here are three practical steps to help:
- First, clarify your thoughts and wishes. Think about who you would want
to speak for you if you can’t speak for yourself. How do you feel
about artificial means prolonging your life and how long would that be
in keeping with your choices? (i.e. hydration, nutrition, mechanical ventilation,
dialysis, tube feeding) What does quality of life mean to you?
- Organize your healthcare wishes and personal information by putting them
in writing to ensure your choices are known. Keep your important papers
together, and inform your family where they are kept. Plan to review them
annually to ensure your wishes reflect your current level of health. Provide
copies to your family, Healthcare Power(s) of Attorney and your medical
- Discuss your plans with loved ones. Inform your healthcare providers/doctors
about your choices. Have an in-depth and ongoing conversation with your
family and friends. Be specific regarding your wishes with your appointed
Healthcare Power(s) of Attorney.
TYPES OF ADVANCE DIRECTIVES – An advance directive is a legal set
of directions you give about the healthcare choices you want if you lose
the ability to make the decisions for yourself. Catawba Valley Medical
Center supports the competent adult’s right to make decisions regarding
the acceptance or refusal of medical, surgical or mental health treatment
in accordance with North Carolina laws.
There are three ways for you to make your directions known:
- A healthcare proxy (durable power of attorney) is a document that names
people you trust to make health decisions if you cannot. This is a different
document than the financial power of attorney.
- A living will or M.O.S.T. form (Medical Order for Scope of Treatment) tells
which treatment you do and do not want if your life is threatened. These
may include decisions regarding:
- Dialysis and ventilators (either short or long term)
- Resuscitation attempts if you stop breathing or if your heart stops
- Tube feeding/artificial hydration or nutrition
- Organ or tissue donation after you die
- Advance Instruction for Mental Health Treatment
MAKING AN ADVANCE DIRECTIVE IS EASY – Advance directives are available
at CVMC, from your primary care provider, attorney,
local Area Agency on Aging, or
state health department. Your directives must be written and signed by you while you are able
to understand your condition and treatment choices and to make those choices
known. All types of advance directives must be witnessed by qualified
people and some must be notarized. Medical center staff members cannot
be used as witnesses. We will provide a notary should you wish to make
an advance directive while a patient here. These forms meet all of the
rules for a formal advance directive. Using the special form is the best
way to make sure that your wishes are carried out.
WHAT TO DO WITH YOUR ADVANCE DIRECTIVES – All patients are asked
if they have advance directives. The patient’s response is then
documented in his or her medical record. Information will be provided
for each inpatient at Catawba Valley Medical Center.
In order to implement a patient’s advance directive, Catawba Valley
Medical Center has made the following provisions:
- When a copy of the patient’s advance directive is provided, the admitting
nurse will place it in the patient’s chart.
- If a copy of the patient’s advance directive is not available, the
admitting nurse will complete an Advance Directive Summary and place it
in the patient’s chart.
- The attending physician will be notified of the existence of the advance
directive immediately upon admission.
- The advance directive will be prominently placed in the patient’s
chart along with an advance directive sticker, which will inform all medical
personnel and medical center staff about the existence of the document.
Click the following link for an available download of a simplified form
that consolidates the
Living Will and the Health Care Power of Attorney. For more information about CVMC Palliative Medicine or Palliative Services,
please contact Laura Parker, FNP-BC, Palliative Medicine nurse practitioner at