Advance care planning: Start the conversation

By Tamera Manzanares

It can be difficult to talk about life’s uncertainties, especially those involving end-of-life. Honest conversations and planning, however, can give us peace of mind and empower our loved ones to make difficult choices even in the most unpredictable situations.

Advance care planning can help ensure your wishes for medical care will be respected if you cannot make those decisions for yourself. Dawn Mathews, a medical social worker for Northwest Colorado Health’s hospice program, has worked with hospice patients and families for more than 10 years. She’s seen the stress and complications that can arise when there is no advance directive to guide decisions.

“If it’s not written down, there can be many different interpretations, and this can cause conflict and suffering within families,” she said. “Talking with your family and recording your wishes before anything like that happens can be one of the greatest gifts you can give to your loved ones.”

The first step is to think about, in the event of a healthcare crisis, what kind of end-of-life care you would or wouldn’t want. Your health care provider can help you understand different life-saving scenarios and how these could play into your current health situation. Discussions with health care providers about advance care planning is a service covered under Medicare.

“People often say to me that they would never want to go on life support ‘if there is no hope,” said Anna Lundeen, a family practice physician with Northwest Colorado Health. “What’s tough about that is, as medical professionals, we can’t predict the future, so we don’t always know if there is hope or what hope looks like to an individual.”

If your heart stopped, would you want CPR? Would you want a machine to breathe for you if you were unable to breathe on your own? Would you want to have artificial fluids or nutrition if you were unable to eat or drink? “These are really difficult questions and all very personal and should be discussed individually with your family and health care provider,” Lundeen said.

When you feel secure in your decisions, document them in an advance directive. There are two parts: Medical Durable Power of Attorney and a Living Will. A Medical Durable Power of Attorney appoints a substitute decision maker or healthcare agent. A Living Will directs doctors to stop or not start life-sustaining treatments if you are in a terminal condition and cannot make your own decisions. Other advance directives are available to cover more specific medical issues or procedures, such as CPR, that are not covered in the basic living will.

In Colorado, your final advance directive documents must have your signature and that of two witnesses. Some states require your signature be notarized. Keep your advance directives in a place that is easily accessible. Give copies to family members, your health care provider and anyone likely to be involved in your medical care. Take copies with you when you check in to a health care facility for inpatient or outpatient procedure. You may want to make a card for your wallet indicating that you have an advance directive.

In the end, the thought and effort that goes into advance care planning can be small compared to the calmness and clarity it will provide loved ones in the face of a very emotional and stressful situation. “If everyone is on the same page in terms of their loved one’s wishes, we are much more likely to make the decisions that are right for that individual,” Lundeen said.

Download a free advance directive and find more advance care planning resources here.

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