Advance Care Planning

Whether you’re young or old, healthy or ill, making your healthcare wishes and end-of-life priorities known in advance is critical. In the case of a devastating accident, medical emergency, or serious illness, advanced planning can ensure that you receive the kind of treatment that you want, reduce the stress on your family, and help avoid family conflicts. One of the greatest gifts you can give your loved ones is to let them know your end-of-life wishes!

In addition to talking with your doctor and your loved ones about end-of-life care, several important documents can help ensure that your healthcare wishes are clearly communicated. These include Advance Healthcare Directives for anyone 18 or older and the DMOST / POLST for people nearing the end of life due to a serious illness or frailty.

Let’s take a closer look at some of these documents.

Advance Healthcare Directives: Speak for yourself BEFORE you can’t

Advance Healthcare Directives are written legal documents that outline your healthcare wishes if you should become unable to speak for yourself. They’re easy to complete and can be modified at any time. In fact, we recommend updating your Advance Healthcare Directive every 2 to 3 years, or sooner if your health changes. Anyone 18 or older can and should consider putting an Advance Healthcare Directive in place. Without an Advance Healthcare Directive, someone else will be appointed to make medical decisions for you if you should become incapacitated.

An Advance Healthcare Directive can be a Living Will, a Healthcare Power of Attorney, or a combination of the two.

LIVING WILL

A Living Will is a legal document that spells out the types of medical treatment you want in the future if you should become incapable of communicating your wishes. It can be as specific or as general as you want. A Living Will can outline your wishes regarding your healthcare in specific situations and for specific services, such as whether you want CPR, dialysis, a feeding tube, IV hydration, a ventilator, pain relief, or antibiotics. Most Living Wills include a general statement that in effect says: “If I suffer an incurable, irreversible illness, disease, or condition and my attending physician determines that my condition is terminal, I direct that life-sustaining measures that would serve only to prolong my dying be withheld or discontinued.” A Living Will may also include a provision indicating whether you want to donate your viable organs to others when you die.

HEALTHCARE POWER OF ATTORNEY

A Healthcare Power of Attorney is a legal document designating any person you choose to make medical decisions for you if you should become temporarily or permanently unable to make those decisions for yourself. Your healthcare “agent,” as this person is called, has the same rights to request or refuse treatment that you would have if you were capable of making and communicating those decisions. One advantage of having a healthcare agent is that they can make medical decisions based on the most up-to-date treatment information.

It’s important to note that a Healthcare Power of Attorney is different from a Durable Personal Power of Attorney. In Delaware, a Durable Personal Power of Attorney allows an individual to make bank transactions, sign Social Security checks, apply for disability, or simply write checks to pay bills. It doesn’t grant authority to make healthcare decisions. In Delaware, you can designate whether your Durable Personal Power of Attorney becomes effective immediately or only if you become incapacitated.

Each state has its own laws about Advance Healthcare Directives, including how they are prepared, when they go into effect, and even how your instructions will be applied. Some states require Advance Healthcare Directives to be witnessed, some require them to be signed before a notary, and some recommend a standard form. Legal forms for Advance Healthcare Directives are available at your doctor’s or lawyer’s office, hospital, health department, and your state’s department on aging.

You can change or cancel Advance Healthcare Directives at any time provided you are considered competent and able to clearly indicate your desires. Any changes or cancellations need to be signed and notarized according to your state laws.

Whenever you make, change or cancel your Advance Healthcare Directive, it’s important to give copies to your family, caregivers, and healthcare providers.

Tools for seriously or terminally ill individuals: Avoid confusion in emergencies

In addition to Advance Healthcare Directives, there are several tools that are extremely useful for individuals with a serious or terminal illness.

DO NOT RESUSCITATE (DNR) ORDER

A DNR can be helpful if you have a terminal condition and do not want to be resuscitated if your heart stops beating or you stop breathing. Rather than a legal document, a DNR is a medical order from your doctor that tells medical staff that you do not want CPR. Even though your Advance Healthcare Directive may indicate this, a DNR order becomes part of your medical record and may help reduce confusion in an emergency. Some states issue DNR bracelets, wallet cards, or other identifiers to help EMTs and medical staff recognize individuals with DNR orders. Separate DNR orders for in-hospital and out-of-hospital situations may be needed or available depending on the state.

DMOST / PAPOLST / POLST

The DMOST (Delaware Medical Orders for Scope of Treatment), PAPOLST (Pennsylvania Orders for Life Sustaining Treatment), or more generically the POLST (Physician Orders for Life Sustaining Treatment) are portable medical orders signed by both a patient and their physician. They clearly state the patient’s specific wishes for medical treatment at the end of life, based upon a detailed conversation between the patient and physician. The form should be updated regularly as health conditions change. The DMOST / PAPOLST/ POLST is not a replacement for an Advance Healthcare Directive and can be changed by the patient’s healthcare agent if needed.

In Delaware, the DMOST form stays with the patient at all times in the provided pink envelope. In Pennsylvania, the PAPOLST gets printed on specific pink paper.

Just a starting point

This information is just a starting point to help you plan ahead for life’s foreseeable and unforeseeable medical emergencies. It isn’t a suitable substitute for professional, medical, or legal advice.

Your Delaware Hospice team is here to walk you through the process and to connect you with the appropriate resources! Honoring Choices Delaware is also available to help you consider your advance planning options.