Advance Care Planning

Advance care planning is an ongoing discussion about your health care goals, values, and wishes for the future.

Calvary Hospital encourages you to start a dialog with your family, friends and medical team about your future health care preferences.

Advance care planning starts with a conversation. And while it’s not an easy discussion to have; it is an important one. Your family, close friends, and medical team need to know what your desires are as you consider your options for your future health care and plan for a number of common scenarios.

Having a plan in place before an event occurs is critical. In many common medical situations, doctors need to make choices, sometimes quickly. If you’ve previously expressed your wishes, you will help your family and medical team make these decisions with the confidence that they are acting as you would have wanted.

Because your health care wishes may change over time, advance care planning shouldn’t be a single conversation. It needs to be an ongoing discussion that will allow you to make adjustments as your needs change.

Calvary Hospital has put together a list of advance care planning steps for patients and families.

1. Choose a loved one as a health care agent who can make decisions on your behalf.
   • This person will advocate for you and make medical decisions ensuring you get the care you would want based on your expressed health care goals, values, and wishes.
   • Discuss your wishes with your health care agent and make sure they are comfortable being an advocate for you.
2. Put a health care proxy in place. (See below).
3. Plan a meeting with your health care provider.
   • Discuss your health care wishes with your healthcare provider(s) and provide them with a copy of your health care proxy.

Completing advance directives

Advance directives allow you to clearly state your wishes about medical treatment before you need such care.

You should execute the following three advance directives:

1. Health care proxy – This legal document identifies the person you trust to serve as your health care agent. The agent makes health care choices for you only if you are unable to communicate or make decisions for yourself.
2. Living Will – A guideline for others, this document outlines what treatments you want to have and which ones you do not want to have in different health situations.
3. Do-Not-Resuscitate – A do-not-resuscitate order (DNR) is a medical order written by a doctor. It instructs health care providers not to do cardiopulmonary resuscitation (CPR) if a patient’s breathing stops or if the patient’s heart stops beating. A DNR order must be created before an emergency occurs.¹

The New York Health Care Proxy Law

The New York Health Care Proxy Law allows you to appoint someone you trust – usually a family member or close friend – to make healthcare decisions for you if you lose the ability to make decisions yourself. By appointing a health care agent, you can make sure that health care providers follow your wishes.²

Anyone over the age of 18 and regardless of current health should appoint a health care agent. A health care agent in two specific situations:

1. 1. Temporary inability to make healthcare decisions, regardless of your age
   • For example, if you were having an outpatient surgical procedure in which you were under general anesthesia and something unexpected occurred, requiring that a health care decision be made, your health care agent could make that decision. Once you became conscious, the health care agent would no longer have any authority to act.
2. Permanent inability to make health care decisions
   • Examples of this situation would be if you were comatose from a terminal illness, in a persistent vegetative state, had an illness that left you unable to think clearly or communicate, or suffered from dementia or Alzheimer’s disease.
   • Your health care agent could be your voice and make your health care decisions according to your own wishes or your best interests.
   • Your agent could also decide how your wishes apply as your medical condition changes. Hospitals, doctors, and other healthcare providers would be obligated to follow your agent’s decisions as if they were your own.
   • You can give your health care agent as little or as much authority as you want. You can allow your agent to make all health care decisions or only certain ones. You can also give your agent specific instructions to follow.
   • The form in which you appoint your health care agent can also be used to document your wishes or instructions with regard to organ and/or tissue donation.

Resources and Tools for Advance Care Planning

Making decisions about how you want to live the remainder of your life and appointing the appropriate person to be your health care agent can be overwhelming. In order to assist in the decision-making process, we recommend that you take the following three steps:

1. Clarify Values and Beliefs
   Not sure where to begin? Tools, such as a values assessment, may help to pinpoint key feelings and opinions about how you want to live the remainder of your life. Such tools can be found at the following websites:
   • Welcome to the Compassion and Support Home Page
   • Aging With Dignity – to Help You and Your Family Plan and Receive the Care You Deserve
2. Choose a Health Care Agent
   • As mentioned earlier, choosing a health care agent to speak for you and make decisions when you are unable is a task that each adult needs to make, regardless of age or health care status. Your agent will advocate for your preferred treatment and ensure that your wishes are carried out at a point in time when you cannot speak for yourself.
   • Once you’ve chosen your agent, you should share your wishes, thoughts, and opinions about how you want to live the remainder of your life. While you won’t be able to predict every scenario that may present itself in a healthcare situation, explaining your feelings and preferences will give your agent the information necessary to confidently make decisions on your behalf.
3. Discuss Your Wishes
   • You should communicate your wishes to your health care providers, particularly your primary care provider. This information will enable your providers to care for you in a manner that is consistent with your wishes.
   • Discuss Your Wishes – Compassion and Support at the End of Life

Practical Issues

Once you have completed and signed your Health Care Proxy, give a copy to your appointed health care agent, primary care provider, and other family members. You may also consider carrying a copy in your wallet or purse, in case of emergency.

Additional Resources:

• Advance Care Planning for Patients and Families

References:

• ¹ https://medlineplus.gov/ency/patientinstructions/000473.htm
• ² http://decidewny.org/forms/
• http://www.compassionandsupport.org
• http://www.agingwithdignity.org
• https://compassionandsupport.org/advance-care-planning/cccc/advance-directives
• https://compassionandsupport.org/advance-care-planning
• https://www.health.ny.gov