Planning Ahead

Making Your Wishes Known

It is important that patients have an early conversation with their physicians and trusted caregivers about health care wishes at the end of life. Known as advance care planning, this discussion and decision-making involves designating a trusted person as your health care agent by completing a health care proxy form. Knowledgeable about your medical situation and your goals, values and wishes, this person has the authority to make health care decisions that support your treatment wishes and personal beliefs if you are too sick or hurt to express your wishes yourself.

Communicating end-of-life wishes to loved ones, appointing a healthcare agent, and addressing financial issues such as wills and paying for care are some of the important issues you can address today to plan ahead.

Don’t Delay Advance Care Planning

Palliative Care Nurse Practitioner Catherine Duffy writes about the importance of advance care planning.

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Advanced Directives

This episode of Timing is Everything includes discussion on health care proxy, power of attorney and other health directives.

Advance Directives

An advance directive is a legal document that describes the type of medical care you want to receive if you become unable to make medical decisions yourself.

Health Care Proxy

The Massachusetts Health Care Proxy form is a legal document that lets you name someone to make decisions about your medical care—including decisions about life support—if you can no longer speak for yourself. It goes into effect when your doctor determines you cannot communicate your health care decisions. A medical power of attorney (or healthcare proxy) allows you to appoint a person you trust as your healthcare agent (or surrogate decision maker), who is authorized to make medical decisions on your behalf.

Personal Directive or Living Will

A personal directive or living will describes what type of future medical treatment you want or don’t want when you are seriously ill. Living wills are not legally binding in Massachusetts. However, they may be used together with a Massachusetts Health Care Proxy form to guide family members and doctors about how aggressively to use treatments to delay death.

Medical Orders for Life-Sustaining Treatment (MOLST)

MOLST is a medical order and written instructions about certain life-sustaining medical treatments, from a physician, nurse practitioner or physician assistant to other helath professionals (e.g. 911 emergency responders, nurses) based on the patient's stated preferences. The MOLST form includes instructions about resuscitation and other life-sustaining measures. And, unlike a Do Not Resuscitate (DNR) order, the MOLST form can be used to refuse or request treatment. These decisions can be changed at any time to reflect current wishes.

Resources

• National Hospice and Palliative Care Organizations' Caring Connections (planning documents and health care proxy form)
• Honoring Choices Massachusetts (Getting Started Tool Kit, Next Steps Tool Kit and health care proxy in 15 languages)
• The Conversation Project (planning documents in 10 languages)
• Massachusetts Medical Orders for Life-Sustaining Treatment forms
• Aging with Dignity's Five Wishes (planning documents)