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Advance Care Planning: Medical Care at the End of Life
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Am Fam Physician. 1999 Feb 1;59(3):613-614.
See related article on advance care planning.
What is advance care planning?
Talking with your doctor about your wishes for medical care at the end of your life is called advance care planning. It's a way for you and your doctor to discuss the kinds of care you want and the kinds of care you don't want at that time. You can tell your doctor about the care you would want if you become unable to make decisions because of a coma or another medical condition that leaves you unable to decide or to speak for yourself. When you write down your wishes, this kind of plan is called an advance directive.
What is an advance directive?
An advance directive is a form that tells your doctor and your family members what kind of care you would like to have if you become unable to make medical decisions. It's called an advance directive because you choose your medical care before you become seriously ill.
When you're admitted to a hospital, the staff must tell you about advance directives. The laws about advance directives are different in each state. Ask your doctor what the laws for advance directives are in your state.
An advance directive lets you say you don't want a certain treatment, such as cardiopulmonary resuscitation (also called CPR). For example, if you have a fatal illness and are near death, you may not want to have CPR if your heart stops. An advance directive can also say that you do want certain treatments, like medicine for pain, or intravenous fluids and tube feedings.
An advance directive also lets you name someone, like your spouse or another close family member, to make decisions for you if you lose your ability to communicate. This is called a durable power of attorney for health care.
What is a durable power of attorney for health care?
A durable power of attorney for health care (also called a DPA) lets you name someone to make medical decisions for you if you are unconscious or unable to make medical decisions for any reason. A DPA can be part of the advance directive form. If you don't know a person you can trust to make these decisions for you, the DPA may not be right for you.
What is a living will?
A living will is another kind of advance directive. It only comes into effect if you're terminally ill. Being terminally ill generally means that you have less than six months to live. In a living will, you can say what kind of treatment you want in certain situations. In this way, a living will is like an advance directive. But a living will doesn't let you name someone to make decisions for you. A DPA is generally more useful than a living will because a DPA lets you name someone to make decisions in your behalf.
If I'm healthy, why should I make an advance directive?
When you're healthy, it's hard to think about the care you want at the end of your life. But it may be the best time to make these decisions. An accident or serious illness can happen any time. Talking with your doctor now gives you a chance to ask questions and talk about your concerns. If you do this when you're healthy, you'll be thinking clearly as you talk about this important topic.
Who needs an advance directive?
Most advance directives are written by older people or by people who are seriously ill. For example, a patient in the last stage of cancer might write an advance directive that says she doesn't want to be put on an artificial respirator if she stops breathing. By letting her doctor know ahead of time that she doesn't want a respirator, she may be able to reduce her suffering at the end of life and increase her control over her death. It may give her peace of mind to know that her doctor knows her wishes and that she won't be put on a respirator if she stops breathing.
How can I write an advance directive?
You can write an advance directive in several ways:
Ask your doctor for a form for writing an advance directive.
Write your wishes on a piece of paper, sign it and date it.
Call your state senator or state representative to get the right form.
Call your lawyer to help you write an advance directive.
Use a computer software package for legal documents.
Advance directives and living wills are not complicated. They can be short, simple statements about what you want done or not done if you can't speak for yourself. Remember, anything you write by yourself or with a computer software package should follow your state laws. So, find out what the laws are in your state. If possible, get your advance directive notarized. Give copies to a family member and to your doctor.
This handout is provided to you by your family doctor and the American Academy of Family Physicians. Other health-related information is available from the AAFP online at http://familydoctor.org.
This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject.
Copyright © 1999 by the American Academy of Family Physicians.
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