The importance of advance care planning and directives

Older senior couple sitting together looking at a computer as go through advance care planning.

Advance care planning involves making crucial decisions about health care before they become necessary. It can provide clarity and comfort during challenging times.

Creating an advance directive is an important part of advance care planning. An advance directive is a legal document that outlines an individual's decisions.

Dr. Dan Heinemann, retired vice president and medical officer of the Sanford Health Network, shared his insights on advance care planning in a conversation with Alan Helgeson on the “A Better You” Sanford Health radio show.

Dr. Heinemann's experiences overseeing health care facilities during the pandemic highlighted the significance of advance care planning, which can guide families through complex decisions. This proactive approach offers solace, ensuring that end-of-life choices align with patients' preferences.

Creating an advance care plan

Dr. Heinemann says it's important for individuals and their families to understand their preferences concerning hospitalization, aggressive care and treatment methods.

There are three essential legal documents involved in establishing a comprehensive care plan:

  1. Advance directive or durable power of attorney: Designates a health care decision-maker.
  2. Living will: Individuals outline their health care preferences.
  3. Medical Orders of Scope of Treatment: Physical orders aligned with health care wishes, facilitated by a trusted primary care source. It could be a doctor, nurse practitioner or physician assistant.

Advance directives encompass diverse documents and issues that could be part of your advance care planning, including:

  • Account information for banks, computers and life insurance policies
  • Do Not Resuscitate (DNR) orders
  • Financial and property considerations
  • Guardianship plans for children
  • Provider Orders for Life-Sustaining Treatment (POLST)
  • Preferences for hospice care, organ donation and funerals
  • Religious practices
  • Specific medical treatment and decisions for various conditions

Not easy, but easier

Dr. Heineman's father Floyd “Bud” Heinemann was an active 90-year-old who was still volunteering at the Sanford Medical Center four days a week as he approached his 91st birthday. Last April, however, he called his son in the morning and said he wasn't feeling very well. He was going to the hospital because he had a terrible headache.
Hours later he was unresponsive and never regained consciousness.

“He had a viral encephalitis and there was a very high likelihood he would never recover,” Dr. Heinemann says. “He'd never be able to go back and volunteer and do all the things he liked to do.”

Dr. Heinemann and his siblings had prior conversations with their father about how he wanted things to work should he be in this situation. So, when the time came and the elder Heinemann was not able to express his wishes, Dr. Heinemann and his family knew their father did not want aggressive treatment or care, nor did he want antibiotics. He wanted to be kept comfortable.

“It made it easier for me, but I wouldn't say it was easy,” states Dr. Heinemann. “It was easier because I knew what he wanted. We had agreed that that's what we were going to do. It was easy then to say no to some of the things that the health care team would offer in terms of care for my father. And it could have had a totally different outcome in terms of anxiety, stress, uncomfortableness — and pain on his part — because we would have drawn things out.”

Tips on talking to your family

Even though it might be uncomfortable, it's important to start advance care planning while your loved one is capable of making informed choices. Assure them that discussing these decisions is crucial for understanding each other's wishes.

Gather resources, consult professionals and discuss preferences with loved ones. This ensures that your health care wishes are honored and alleviates stress on your family during critical moments.

Share the content of living wills or durable power of attorney documents and explain the rationale behind choices. Make sure preferences related to illness, quality of life, faith and end-of-life circumstances are included.

Respect differing opinions and use discussions as an opportunity to communicate reasons behind the decisions.

Navigating legalities

Every state has unique laws regarding how your advance directives are drawn up and filed. You can learn more from your doctor, attorney, social worker or county human services office.

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