Advance care planning: a loving act

Ensuring your loved one’s end-of-life wishes are honored.

In no circumstance is end-of-life care an easy conversation, but if you ever find yourself needing to make those tough decisions for a loved one, it’s comforting to know what they want. Advance care planning helps ensure their wishes are clearly understood and respected. By having a series of meaningful conversations and preparing the necessary documents, you can help ease the stress associated with such a responsibility.

Advance care planning documents

The most crucial part of advance care planning is the discussions with your loved one about their choices for medical treatment at the end of their life. It’s also important for them to record their preferences in legal documents that can be shared with medical professionals.

Advance directives are the documents that fall under the advance care planning umbrella, and can include:

• A living will lets you approve or decline specific medical care, even if it means death is imminent. Generally, this document can be used to decline life-prolonging treatments. In some states, it only applies under certain circumstances such as terminal illness or injury, but it’s still valuable to document your wishes.
• A durable power of attorney for healthcare, also known as a healthcare proxy or surrogate, lets you appoint a representative to make medical decisions for you and specify the extent of their authority.
• A do not resuscitate (DNR) order instructs medical personnel not to perform CPR if you go into cardiac arrest or breathing ceases. There are two types of DNRs, one that is effective all the time and another this is only effective while you’re hospitalized.

While a living will might not seem essential if there’s a healthcare proxy, having a written document to help guide specific treatment preferences is ideal. The more information you have about your loved one’s wishes, the better you can ensure those wishes are carried out.

Something to note is that advance directives can always be updated as circumstances change; don’t be afraid to establish them early. A significant medical event or major family change can prompt a reevaluation at any time.

Advance care planning objectives

At the heart of overseeing your family member’s care is respecting their choices regardless of your personal feelings. Even if you have opinions that conflict with theirs, they chose you to implement their plan because they trust you to follow it as they’ve outlined. This also means understanding their religious and cultural preferences, and how these will influence their end-of-life care.

The goals of advance care planning are to respect individual patient autonomy, improve quality of care and reduce overtreatment. “Conversations around aging preferences and advance care should occur early and often. With the prevalence of dementia and cognitive decline, prioritizing discussions are vital to ensure loved ones receive the care they want and need,” says Emily Treasure, senior manager of longevity planning at Raymond James. By partnering with your loved one in preparation, you can strengthen your bond and make them feel at ease about the care they’ll receive as they age.

Sadly, differing opinions about end-of-life care can make it tough for families to reach a mutual agreement about how to care for their loved one. Emily recommends establishing advanced care preferences and finalizing directives early – long before a crisis arises. Putting these plans in place early ensures that the patient’s wishes are clearly documented, reducing the emotional burden on families during difficult times and preventing rushed decisions, helping families to respect their loved one’s wishes.

Doctors may not always start advance care planning conversations with patients, so advance care planning tasks often are left to family members or close friends. Seeking support from others who’ve undergone the planning process may help. Additionally, numerous government, legal and medical resources are available – from conversation starters from the National Institute on Aging to advance directive forms by state from AARP.

Implementing advance care planning

The purpose of advance care planning is to be prepared to make decisions that align with your family member’s values. Even with a living will, some scenarios may not be clearly outlined. If this is the case, decision-making strategies can guide a healthcare proxy’s choices.

Substituted judgement, the preferred decision-making method, involves putting yourself in the place of the person needing care and trying to choose as they would. This may mean remembering your loved one’s strong opinions about a neighbor’s care choices and what types of medical care they’d refuse.

The “best interests” approach, sometimes used in conjunction with substituted judgment, involves considering whether a specific treatment is in your family member’s best interest; in other words, whether it improves quality of life or simply extends a condition of pain and discomfort.

When making these decisions, think about what your family member believed gave their life meaning and purpose, and whether they can still participate in those activities. This intimate knowledge, along with input from medical professionals, should guide your choices.

While the topic is uncomfortable to broach, remember that making care decisions for your family member if they’re unable to do so is a loving act. With thoughtful discussions and thorough documentation, you’ll be prepared to honor your loved one’s requests if the time comes.

Sources: AARP, National Institute on Aging