Developing and Managing Advance Directives

As a Caregiver, you want to do everything you can to honor the choices of your loved one in moments of medical distress and in dying. An Advance Directive - a written statement of a person's wishes regarding medical treatment - is a document that will ensure decisions are made in line with your loved one’s values, even when they are no longer able to communicate.


An Advance Directive is a legal document that goes into effect only if someone is unable to speak for themselves as a result of disease or severe injury. There are several elements to an Advance Directive: a medical power of attorney and a living will. In these documents, a person has the opportunity to consider their values and desires related to end-of-life care. Do I want to be put on a ventilator? If my heart or breathing stops, do I want doctors to resuscitate me? Do I want to be fed through a feeding tube? Without an Advance Directive, the burden of these decisions fall into the hands of a family member, often at a time of extreme emotional stress.


In life, the one certainty we have is death. Communicating and planning for end of life care while a person is still of sound mind and can ensure their values regarding end-of-life care are upheld. Now that medical technologies have advanced to a point where life can be sustained by machines and medication, we have to make the decisions together of when a patient wants to be sustained by technology and at what point a natural death would be more ideal than the quality of life the medical intervention will provide.


Starting the Conversation with your Loved One

Death is a challenging topic to broach, but it is an important part of caregiving, to ensure the care you are giving matches the values and desires of your loved one. When discussing end of life care, you can visit the topic on a rest-of-life approach. Instead of focusing on death, focus on how they want to live out the rest of their days.


The best thing to do, may be to have this conversation with your loved one’s physician. A medical professional can help guide end-of-life conversations and spell out all the potential decisions that may need to be made.


Once you have discussed your loved one’s end-of-life wishes, you may choose to engage a lawyer to develop the Power of Attorney and a Living Will.


For additional resources in having a conversation with your loved one, visit The Conversation Project (theconversationproject.org).


Durable Power of Attorney for Health Care

A durable Power of Attorney allows the patient to name a person (like their Caregiver) to make decisions regarding their health care. This is a decision you can make with your loved one - who will be the main healthcare proxy, and then also an alternate proxy. Ensure each proxy is aware of all end-of-life wishes.


Living Will

A living will is the advance care directive, a legal document that communicates the patient's wishes to doctors should they be dying or permanently unconscious. The living will is especially important should a healthcare proxy be unavailable to make decisions. This written document will allow doctors and caregivers unfamiliar with the patient's wishes to make sound decisions regarding end of life care.


The best way to start planning both the Power of Attorney and Living Will is to discuss with your doctor all the different scenarios that must be considered for a full Advance Directive.

California requires that the Advance Care Directive be notarized or that two adult witnesses who are not designated in the Directive are present at signing.


The Advanced Directive form can be found online here: https://oag.ca.gov/sites/all/files/agweb/pdfs/consumers/ProbateCodeAdvancedHealthCareDirectiveForm-fillable.pdf


Once the Advance Directive is finalized, ensure the healthcare proxy and any alternate proxies have copies. Also give a copy to the patient’s doctor to keep on file with their medical records.


POLST

Another important document to complete is the Physician Orders for Life-Sustaining Treatment (POLST). This is a form that gives seriously-ill patients more control over their end-of-life care, including medical treatment, extraordinary measures (such as a ventilator or feeding tube) and CPR. Printed on bright pink paper, and signed by both a patient and physician, nurse practitioner or physician assistant, POLST can prevent unwanted or ineffective treatments, reduce patient and family suffering, and ensure that a patient's wishes are honored.


The POLST from can be found online here: https://capolst.org/polst-for-healthcare-providers/forms/


While you are planning out the advance care, take the time to ensure any outstanding paperwork and legal documents are organized and filed where family members can easily access them.


Advance care planning is wise for people in all stages of life. If you are developing an Advance Directive for your loved one, it could also be a great time to start creating your own. No matter your age, any type of medical crisis can leave one unable to make decisions regarding their care.


Providing an Advance Directive allows medical professionals and family to make informed decisions based on the patient’s wishes made when they are of sound mind.


Additional resources to support preparing an Advanced Directive can be found at Providence Institute for Human Caring (instituteforhumancaring.org).