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Why should families discuss end of life care?

Thinking about end of life care, and the decisions you would like to have made if faced with a medical emergency are not necessarily on top of anyone’s to-do list. This is, of course, a difficult subject to consider and may be even harder to discuss with family, but it’s important for everyone.

Advance care planning can help ensure your personal values and intentions are carried through, and alleviate burden on family members, in a sudden or unexpected crisis. The best time to have these discussions is while you are healthy and mentally capable of making these decisions and your wishes known to those closest to you. Here are some of the reasons to review, document and communicate your wishes.

Express your personal values

A key topic in advance care planning is the use of life-sustaining treatments and comfort care. This is a very personal decision, and requires careful thought from the individual. Consider a few different scenarios, and how you would like your care managed on your behalf, if you are unable to do so yourself. For example, if a heart attack left you unable to breathe, would you desire to have CPR performed on you? If a medical emergency occurred leaving you unresponsive, what types of measures would you like taken to preserve your life? While some people seek a higher quality of life and less medical intervention, others may wish to have their life mechanically sustained through measures such as intubation and artificial nutrition for as long as possible. Essentially, you need to contemplate and communicate under what circumstances you would want life sustaining technology or interventions withheld.

If you’re not sure how to spark the conversation, the National Hospice and Palliative Care Organization provides a helpful guide with trigger points and strategies to begin this important discussion with family and friends.

Make sure key documents are in place

Advance directives are written, legal instructions regarding your preferences for medical treatment, in the event that you are unable to make decisions for yourself. While seniors may be more likely to have a formalized advance care directive, documentation should be considered for any age, in the event of an unexpected medical crisis. Key components of advance care plans include:

  • Designating your power of attorney or health care proxy—everyone should designate a family member or trusted friend to be their spokesperson for managing emergency medical care, in the event they cannot. It’s important to discuss your wishes with your power of attorney. You may also include an alternative person, in case for some reason your power of attorney becomes unable to act on your behalf.
  • Living will—a living will is a legal document that outlines your personal preferences for end-of-life medical treatments such as CPR, pain medication and organ donation. A living will is not the same as a will, which outlines how you would like your assets to be allocated after your death.
  • DNR orders— In addition to your living will, some people will choose to include DNR (do-not-resuscitate) order which instructs the hospital not to perform CPR or other life saving measures in the event the heart stops beating. This form can also be specified for a non-hospital setting, such as a nursing home, if desired. 
  • Advance directive forms— Much of the information above can also be documented in an advance care directive form, which varies by state. You can visit AARP’s website to download and print the forms needed in your state.

Having legal documents in place is an important step, but you’ll also want to make sure these documents are shared with others. Keep originals and copies in a secure, yet accessible place. It’s recommended to provide copies to your power of attorney (health care proxy), to family members, medical providers, and perhaps even clergy members if issues of religious practice factor into your decisions.

Remember, while it’s not a pleasant conversation, it’s an important one. For some, having a legal document can help to broach the subject with loved ones. It also provides written instructions for those who may face difficulties in discussing each and every detail.

Reduce burden and uncertainty

End-of-life situations are difficult and wrought with emotions. Advanced planning helps guide loved ones with well documented, dispassionate instructions to make difficult decisions for them and consistent with your wishes. We all want our family to have an easy time managing our care, and the many difficult aspects associated with end-of-life circumstances. The emotional sting of loss can make handling these tasks all the more challenging. Having meaningful conversations ahead of time, and ensuring legal documents are squared away, can help families get through the grieving process and focus on honoring their loved one.

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