Avoid Confusion: Make Your Wishes Known Now

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:

  1. 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?
  1. 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 provider(s).
  1. 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:

  1. 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.
  1. 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
  1. 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 lparker@catawbavalleymc.org.

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