Advanced Care Planning

A Living Will lets your wishes be known regarding your medical care and the measures you would want taken to either sustain your life, or discontinue life-saving care, in the event you are unable to make these decisions yourself. By letting your loved ones or caregivers know ahead of time what your final wishes are for your care, it removes a burden from them, and eliminates any guilt they may have by making decisions that you may not have wanted.

A Health Care Proxy or Power of Attorney for Health Care is a designative advance directive. It allows a person to designate their agent or surrogate decision-maker regarding health/medical care should they lose decision-making capacity. Such decision-making does not have to be limited to life-sustaining medical care or final wishes. They are regulated differently in every state.

Your health care agent (also called a proxy or representative) should preferably be a person who is most familiar with your wishes, and whom you would trust to speak for you if you are unable to do so. It is important to have these wishes in writing, making sure that your health care agent has a written copy. Your health care providers should also be given a copy of your written plans to make sure that your wishes are honored. New copies should be given any time you make changes to your plans.

Not everyone will feel comfortable serving as a health care agent. It’s important to talk openly and honestly with the person before making a decision. 

An Instructional Advance Directive allows a person to write down their wishes or instructions regarding treatment when they are terminally ill or permanently unconscious.

An Arizona Blood and Cancer Specialists’ Palliative Nurse Practitioner is available to discuss your wishes and goals of your care and explain the Advance Care Planning process. Specific details about your health care choices and options will be fully explored, including:

• Cardio-Pulmonary Resuscitation (CPR)
• Intubation (Mechanical Breathing)
• Dialysis
• Medication to fight infection or replace a failing bodily function
• Artificial Nutrition and Hydration
• Pain Control and Comfort Care
• Palliative Care
• Hospice Care

While our Palliative Nurse Practitioner can help you better understand what your health care choices are, when you are ready to move forward with your plans, you will need to work with your family and/or a professional advisor to create your Advance Directive.

Terminology

When you are in the process of your Advance Care Planning, these are some terms you may hear. It is helpful to understand what each of them is.

Comfort Measures/Comfort Care is medical and supportive care that makes a person comfortable at the end of life by relieving pain and other symptoms. This type of care is not focused on curing or prolonging life.  

Do-Not-Intubate Order (DNI) is written by a physician that communicates a person’s wish to not have a breathing tube at the end of life.

Do-Not-Resuscitate (DNR) Order, Do Not Attempt Resuscitation (DNAR) or Allow Natural Death (AND) are documents signed by a physician indicating that a person does not want medical personnel to perform cardiopulmonary resuscitation (CPR) or other life-support measures to restore breathing and the normal rhythm of the heart.  In Arizona, this document must be printed on bright orange paper.

Palliative Care is different than Hospice Care. Palliative Care provides support for patients facing debilitating chronic diseases and life-threatening illnesses. It helps a patient improve their quality of life, deal with side effects, reduce their anxiety and depression, and provide effective pain control. Palliative care can be offered at any stage of any illness, while hospice care is used during the last stages of life for patients who are ready to discontinue life prolonging or curative treatments.

Hospice care provides quality of life for a person in the final stages of an advanced, life-limiting illness. The goal of hospice care is to help a person so that they may live as fully and comfortably as possible. It is focused on treating a person’s symptoms instead of treating their disease. It does not hasten or postpone a person’s death. Hospice care also provides emotional support to caregivers during a difficult time ensuring that during a person’s final days, they are treated with dignity and compassion.

A Power of Attorney can authorize another person to act on your behalf in matters such as health care or finances depending on the type of Power of Attorney you sign. When you appoint a Durable Power of Attorney, their authority to act on your behalf remains in effect if you become incapacitated, such as due to illness or an accident or decline in cognitive functioning. Making sure that you have these documents in place helps eliminate confusion and uncertainty when difficult decisions need to be made.

Health Care Proxy / Durable Power of Attorney for Health Care is a type of Power of Attorney that appoints a health care advocate to make medical decisions if a person is unable to do so. 

• In most cases, a power of attorney goes into effect when a physician determines a person is either temporarily or permanently not able to make his or her own decisions.
• If a person regains the ability to make decisions, the health care advocate cannot continue to make the decisions. Some states have specific requirements regarding decisions about life-sustaining medical treatments. 

A person that you appoint as a General Durable Power of Attorney can act in a wide range of legal and business matters, including buying and selling property, managing your finances, and filing for tax returns. This person can also apply for government benefits. The person has no legal authority to make health care decisions. This person can be different that the person you appoint as your Health Care Proxy / Durable Power of Attorney for Health Care.