Advance directives: Planning for the unexpected

Coma. Dementia. Traumatic brain injury. Stroke. Anyone can experience unexpected, sudden changes in health at any age. Which medical services would you prefer for your end of life care? Thinking about severe illness, traumatic injuries or loss of our cognition is a difficult and undesirable topic. However, careful consideration of your wishes will allow you to have the care you prefer in the event of the unexpected.

Discussion of your preferences in regards to a living will and advance directives is important regardless of your age or health status. If you are managing chronic illness, take the time to educate yourself on your options with advanced directives and a living will, so that your desires are respected. Several different terms are often used in the discussion of end of life planning and preferences for medical care.

An advanced directive is a document explaining a patient's desires for treatment in the case of severe or terminal illness when the patient is unable to communicate. The completion of the document is beneficial to health care providers and family members when medical care decisions must be made. This document may express your exact desires or appoint a loved one to make medical decisions on your behalf. However, there is no requirement to complete it. If not completed, your health care decisions will be delegated to your next of kin (family member as prioritized by the state of Indiana).

According to the Indiana State Department of Health, there are eight variations of advanced directives recognized in Indiana.

• Discussion with your health care team and loved ones - talking with your medical team and family helps to inform others of your medical care desires. However, written documentation is lacking to specify various situations and for other physicians or healthcare organizations to access.
• Physician Orders for Scope of Treatment (POST) : advance directives and appointment of a health care representative completed by a physician or advanced practice provider (NP, PA) and the patient. This form can be carried by the patient and is reversible at any time.
• Living Will: Requires a witness signature. Is reversible at any time. Living Will Declaration: written to specify your exact preferences for end of life care or the delegation of decisions to a loved one, such as outline of desires regarding: CPR, tube feedings, ventilation, antibiotics, dialysis, comfort interventions, organ donation, dialysis. Also Life-Prolonging procedures Declaration: states to utilize all life-preserving interventions
• Power of Attorney: (also known as agent/proxy/surrogate/advocate) any adult that will make medical decisions for you if you are unable to. Reversible at any time. You may appoint an individual to make health care or financial decisions. The document must include the individual's name and the situations in which he or she are permitted to make decisions on your behalf and specify the exact matters that he or she may act on your behalf. This document must be signed and notarized.
• Health care representative: Someone you choose to make decisions in terms of your medical care only. In order to appoint an individual, you must complete a health care representative document with your signature and that of another adult, signing as a witness. The official document is necessary as this individual will be making quality of life decisions on your behalf and must have your best interest in mind.
• Psychiatric advance directives: Documentation of specific treatment desires or consent to treat specific diagnoses in the case of an inability to make decisions for yourself.
• Out of Hospital Do Not Resuscitate Order (DNR): States your desire to not receive CPR in an emergency situation if this occurs outside of a hospital setting. Contact your local Emergency Medical Service (EMS) department to ask about their procedures and to inform of your preferences.
• Donation of organ and tissue: often this is indicated on your driver's license but may also be indicated on your living will. This is a wonderful opportunity to increase the quality of life for another person.

Beginning the process of considering end of life options is quite challenging. However, it is an important topic to discuss with family members and health care providers in order for your wishes to be respected. Life is unpredictable. As we hope for the best outcomes for each of us, there is no guarantee of avoiding the unexpected. Forms are available to assist you in the development of your advance directives. The Indiana State Department of Health provides resources and documents on the website. Your primary care provider should also be able to provide these documents.

Resources:

CICOA's Aging & Disability Resource Center (ADRC) at 317-803-6131

https://www.in.gov/isdh/files/advanceddirectives.pdf