What would happen if you were severely injured in a car accident or suddenly had a major medical emergency and you were not able to communicate with those who were to provide your care? Who would speak for you? Would they know what medical interventions you wanted or did not want?

With the proper conversations and documents, you can make sure your healthcare wishes are honored, even if you were unable to speak for yourself. We’ll discuss why such a plan is important, how to choose who will speak for you, and what documents are needed legally.

While Living Wills and Healthcare Power of Attorney’s are legal in most states, it’s important to note that advance directives vary from state to state. So, be sure you know which documents you need in your specific state.

What is an Advance Directive?
An advance care plan, otherwise known as an advance directive, is legal documentation that tells your doctor and family members what type of medical care you want if you cannot speak for yourself. For example, you may be in a coma, seriously injured in an accident, have a terminal illness, or living with severe dementia.

It describes the type of treatment you would want or not want, based on how sick you are. If you have an illness you may not recover from, what kind of care would you want? If you are sick or injured and there is a chance you may be permanently unconscious, what type of treatment do you want?

Advance directives include such documents as a Healthcare Power of Attorney, Living Will, Medical Order for Scope of Treatment (MOST) or Physician Orders for Life-Sustaining treatment (POLST), or Do Not Resuscitate order (DNR).
Let’s look at each of these.

Healthcare Power of Attorney
The Healthcare Power of Attorney form lets you specify someone who will speak on your behalf in the event you are unable to speak for yourself in a medical emergency. It becomes active when you are unconscious or unable to make medical decisions for yourself.
While many people choose a spouse or other family member, it can be anyone who you believe will truly advocate for your wishes.
When choosing a Healthcare Power of Attorney, it’s important to keep these things in mind:

• Are they responsive?  Would they be able to be present, either in person or virtually, in an emergency? 
• Are they trustworthy? Can they be trusted to follow your wishes?
• Are they assertive? Can they take the pressure from friends and family in an emotional situation and put your wishes first?
• Can they understand medical processes? Will they ask the right questions about tests, procedures, prognosis, and the value of specific medical interventions?
• Are they articulate? Can they communicate clearly and effectively in an emergency and not get overwhelmed with emotions. Are they confident in their decisions?
• Are they willing to take on this responsibility? Do they feel they can serve in this role?

Living Will
A living will is a legal document that outlines the treatments you would want if you were permanently unconscious or terminally ill. It may be medical treatments that can be used to keep you alive.

Think about what would be important to you. What do you consider to be quality of life and at what point might you feel that lie was not worth living? Would you want your life extended in any situation? All situations? Or, if only a cure was possible? Think about what you want your end-of-life care to include.

Possible medical interventions may include but are not limited to

• Mechanical ventilation – takes over breathing if you’re unable to breathe on your own. Determine when and for how long you would want this.
• Tube feeding – a tube inserted in the stomach of vein that supplies nutrients when you are unable to eat or drink

POSLT/MOST Forms
POLST/MOST forms are documents that you fill out with your doctor as they are medical orders and need a physician’s signature. In 2019, an initiative was led to create a national POLST form. This would make it easier to honor patients’ treatment wishes throughout the United States. Since then most have adopted the use of the form.

To complete a MOST/POLST form, talk to your doctor about filling out the form and having it added to your medical record.

Do Not Resuscitate Order
A DNR means you have made the decision not to be resuscitated or receive CPR in the event of an emergency. It is very specific in its scope and does not have instructions for other medications.

If you are near the end of your life or have a terminal illness, you may decide you want a DNR to ensure a natural death. As CPR can be especially hard physically for someone of an advanced age, seniors may want to weigh the pros and cons of having a DNR in place.
We Can Help You Begin the Conversation
In 2009, Lower Cape Fear Lifecare began Begin the Conversation as an initiative to help educate people about advance care plans and the importance of having a plan in place.

 The agency offers workshops at its corporate offices. Dates and times can be found on the agency’s calendar. These are subject to change due to COVID restrictions and safety precautions. We also offer the workshop free of charge to local churches, groups, and organizations. Simply contact us for more information.

If our workshop is not an option for you, watch our short video that covers all the basics about creating your advance care plan. We also have a free workbook that can help you Begin the Conversation with loved ones and doctors, as well as document important information you want your family and loved ones to have.

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Kelly Erola, MD, FAAHPM, FAAFP, is currently the Chief Medical Officer for Lower Cape Fear LifeCare, based in Wilmington, NC, where she has worked since 2017. Previously, she was Chief Medical Officer for Hospice Savannah, Inc. for 16 years and physician leader of the Steward Center for Palliative Care. Dr. Erola is board certified in hospice and palliative care medicine and has been involved full-time in palliative care since 2002.