Facing our own mortality is an arduous task, perhaps one of the most difficult challenges we will ever encounter. Nevertheless, if we desire a meaningful and peaceful passing, it is crucial that we contemplate it while we are still capable. For most of us, the ideal scenario is to die at home, surrounded by loved ones in a familiar and tranquil environment, rather than spending our final moments in a chaotic emergency room or intensive care unit.
Considering these two options, it is essential that we retain as much control as possible over the decisions that must be made well in advance of our last breaths. We should reflect thoughtfully and thoroughly on what makes life worth living, and decide where the threshold lies beyond which pain and limitations have eroded our quality of life to such an extent that we would rather not endure it.
To achieve this, there are several resources available in each state, collectively referred to as “advance health-care directives.” Here is a step-by-step guide that will assist you in initiating a conversation about your final wishes and in determining which documents are required.
Assign a Healthcare Proxy to Represent You in the Event of Incapacity, if You’re 18 or Above
Determine who in your circle of family and friends is the best person to trust with making critical decisions regarding health care. It’s important that this individual have sound communication skills, stay composed under pressure, and handle conflicting situations while respecting your wishes and evaluating medical options. Depending on where you live they may also be referred to as a “healthcare proxy”; take time for an open dialogue about what would happen if certain scenarios took place – it won’t be easy but resources like “The Conversation” can provide guidance during these difficult conversations.
Granting Authority for Health Care Decisions with a Health Care Power of Attorney (HCPOA)
After you have initiated that discussion, it will be necessary to officially designate your agent by completing a Health Care Power of Attorney (HCPOA) document. An HCPOA grants legal authority to your agent or proxy to make health care decisions on your behalf when you are incapable of doing so.
Health Insurance Portability and Accountability Act (HIPAA) authorization
To enable your agent or proxy to access your otherwise private medical records, it’s recommended to use a standardized document that adheres to the federal Health Insurance Portability and Accountability Act (HIPAA). Without this authorization, your agent will not be able to obtain the necessary medical information to carry out the authority you have entrusted them with.
With the HCPOA, HIPAA authorization, and your designated agent in place, you can rest assured that you have appointed and empowered an advocate to speak on your behalf in the event of an accident or loss of consciousness. It is advised to review and update these documents every five years.
The next three documents are essential for end-of-life situations. All three should indicate that you wish to receive comfort care to ensure you remain clean and pain-free. However, it’s essential to create these documents while you are still able to express your desires, and it’s best to complete them simultaneously with your HCPOA and HIPAA authorization.
Document Your End-of-Life Medical Preferences with a Living Will (Also Referred to as a Physician’s Directive)
No one wants to face the idea of declining health, but it’s important to ensure that your wishes are respected in case you ever experience a life-limiting condition. A Living Will is an essential document for expressing how you want to be treated if and when death becomes inevitable or irreversible unconsciousness sets in. It will help secure decisions such as whether breathing tubes, CPR, antibiotics or chemotherapy should be used – all measures taken with respect so that quality of life can remain at its utmost while ensuring peace has been attained during challenging times.
An advanced directive gives you the option to leave medical decisions in experienced hands. By engaging physicians, rather than your agent, concerning life-prolonging procedures, this relieves your designated representative from having to make an irreversible and emotionally weighty choice on their own.
Specific Instructions for End-of-Life Medical Treatment with Specialized Directives
Medical decision-making can vary depending on specific health conditions, and as a result, specialized directives may be needed. For instance, individuals suffering from advanced dementia can benefit from a directive that specifically requests hand-feeding to be stopped once they are unable to recognize loved ones, move purposefully, or speak. Therefore, for this condition, a customized directive should be created.
In contrast, for neurological diseases like ALS or advanced Parkinson’s, although most individuals may decline mechanical treatments, these treatments can be essential to maintaining a good quality of life.
Remember, it’s important to create these documents while you can still express your wishes. Living wills should be reviewed every six months because your preferences can change as your illness progresses.
Medical Orders for Life-Sustaining Treatment (MOLST) or Physician Orders for Life-Sustaining Treatment (POLST)
This short-form document is designed to provide Emergency Responders and hospitals with recognition of a patient’s wishes in the event they are unresponsive. The POLST or MOLST form should be filled out by both the Patient (or Representative if required) as well their Physican, determining whether Cardio Pulmonary Resuscitation (CPR) and other aggressive treatment measures will take place – upon realization that death within 12 months may occur. Many states throughout America have this service available for those wishing to plan ahead during difficult times.
Ensure Your Documents are Shared: The Importance of Communicating Your End-of-Life Medical Wishes
Be sure that your important documents are never out of sight! Ensure they’re kept in a secure place, such as with an agent or proxy. Additionally, make it easy to find the POLST/MOLST form by displaying it near the bed for quick access if needed.