Usually it takes a crisis, like a car accident or sudden illness, for people to talk about how they would like to be cared for at the end of their lives. When conversations come up after tragic events, families may be too distressed to make informed or appropriate decisions about immediate care needs.
Advance care planning — making your wishes known by writing them down and discussing them with your family — can:
• Reduce the use of invasive treatments such as feeding tubes or ventilators.
• Give you more control over decisions.
• Decrease the likelihood of receiving treatments that go against your wishes.
• Increase the likelihood of dying in a place and manner that you choose.
For family members, advance care planning reduces some of the burden of making decisions and the anxiety that goes with it. It may outline when treatment moves from concentrating on a cure to providing comfort, or palliative care. Bereaved family members whose loved ones relied on hospice services show reduced risks of depression and traumatic grief.
Only one third to one half of all adults in the United States have completed advance care directives, although rates are as high as 70 percent among adults aged 65 or older and adults with terminal illnesses. Prominent cases of contested end-of-life decisions such as that of Terri Schiavo, along with television shows like Bill Moyers’ PBS Series “On Our Own Terms,” or best-selling books like Atul Gawande’s “Being Mortal,” have all raised awareness about the importance of making your wishes known. Public awareness campaigns like National Health Care Decisions Day, which is April 16th, and Five Wishes, help explain the benefits of advance care planning.
Five Wishes, an advance care directive created by the nonprofit organization Aging with Dignity, uses everyday language to convey the choices. RiverStone Health offers the Five Wishes guide through Hospice Services and through the care coordinators at RiverStone Health Clinic. The free guide lets individuals express their medical and legal wishes along with their spiritual and personal needs.
Healthcare providers encourage adults to express and formally document their treatment preferences while they are of sound mind and body. The Patient Self-Determination Act of 1990 requires all healthcare facilities receiving reimbursement from Medicare or Medicaid to ask patients about completing advance care directives, provide information, and incorporate the directives into the patient’s medical record. If you are Medicare eligible, the Medicare Annual Wellness Visit offers a chance to discuss and document your treatment goals and preferences.
While you can’t predict what the future holds, you can think about your values, your beliefs and what’s important to you. Think about it. Talk about it. Share it. Write it down.