National Healthcare Decisions Day
April 16 is recognized annually as National Health Care Decisions Day, but in 2020 it has been moved to July 16. The day is a time to stop and think about who would make medical decisions for us if we suddenly became ill, and what kind of treatments we would want based on our own goals and values. This year, COVID-19 reminded us of the importance of these types of conversations. Our delay in having these conversations is because it often seems too early, then, suddenly, we find it is too late. The severity of illness sometimes seen with COVID-19 makes us realize the need for thoughtful discussions about what kind of treatments we or our family members would want if we could speak for ourselves.
The purpose of National Health Care Decisions Day is to inspire, educate and empower the public and healthcare providers about the importance of advance care planning. It also helps to demystify healthcare decision-making and helps each of us to truly focus on the importance of making our own advance care planning decisions.
Now is the time to have discussions with your family members to understand what matters most and who should be making medical decisions for them.
It’s Not Just for Old People
Illness is difficult to predict, and it’s nondiscriminatory. It can happen at any time, at any age, when you least expect it, and it can leave you unable to make your own decisions about your care. Making health care plans for the future, even if you aren’t sick now, can help to ensure that if a medical crisis does occur, you will receive the care you want in the setting you prefer.
It’s OK If You Aren’t Sure What You Want
There is no “one size fits all” approach to advance care planning. What is right for you may not be right for someone else. The key is to identify what’s important to you, and you can start that process by asking yourself what matters most to you in your life, who you would want to make decisions about your care if you become unable to do so and what types of medical care you do and do not want.
“How to Start the Conversation about Advance Care Planning" is a wonderful, free resource that can help you to prepare your thoughts before you begin the advance care planning process.
It All Starts with a Conversation
Advance care planning begins with a conversation. This conversation may be with your physician, your loved ones, your spiritual leader, your neighbor – whomever you choose, wherever you choose and in whatever location you choose. There are no rules for discussing your end-of-life care wishes, there are no right or wrong answers, and it’s not a discussion that has to be completed in a single day.
For many, it won’t be an easy conversation to have. Death and dying can be an emotional and frightening subject, and some of your loved ones may not be ready to discuss it with you, or they may have different opinions than you. What you must remember is that as difficult as this conversation may be, it would be even more difficult for your loved ones to have to make those decisions for you without knowing what you would and would not have wanted.
Taking the Most Important Step
Once you’ve decided what you want and discussed your wishes with the people important to you, you must take the next step and document your wishes. Here in Louisiana, there are three advance care planning documents available: the advance directive, or “living will”; the health care power of attorney; and Louisiana Physician Orders for Scope of Treatment (LaPOST).
Advance directive: This is a legal document that states what kinds of treatment should be given to you when you can no longer make decisions or speak for yourself. It only goes into effect if you are terminally ill and have lost decision-making capacity, and it is usually completed in advance of any known illness. You complete it yourself, and unless there are other known facts, it must be honored. To become valid, it must include the signatures of two witnesses or notarized.
Health care power of attorney: This document authorizes someone else to make decisions about your health care when you are no longer able to make those decisions or speak for yourself. To become valid, it must include the signatures of two witnesses or be notarized. In Louisiana, there is a very specific order of who can make these decisions for you if you have no written instructions available. If no health care decision maker has been appointed by you, the law establishes a very specific order of who can make decisions for you – those individuals are, in order, your legal guardian (if one has been appointed); spouse (unless legally separated); the majority of your children; your parents; the majority of your siblings; antecedents/descendants; special friends; and your attending physician (under certain circumstances).
LaPOST: The LaPOST document is designed specifically for patients with serious, advanced illnesses and limited life expectancy. It is more than an advance directive or health care power of attorney. It's a medical order that is completed only after you, or your health care representatives, have discussed your goals of care and treatment preferences with your physician. As a medical order, it travels with you across health care settings. When completed, it must be followed by all health care professionals. The LaPOST document may also be used to translate your advance directive into a physician's order.
Having Said All That…
I’ll ask you this: Do you want your loved ones’ last memory of you to be the one of them making decisions about your care at the end of your life? If it’s not, please – for their sake as well as your own – make those decisions now, tell them what you want and document your wishes.
Remember, the worst plan you can have is no plan at all.