Making decisions about future healthcare preferences and sharing those thoughts with family members is a step that many people avoid – until it’s too late.
But if you’re someone who would like to opt out of ICU stays, feeding tubes or artificial ventilation in favor of treatment that simply strives to make you as comfortable as possible, now is the time to consider your preferences for end-of-life care and put them in writing. Most importantly, it’s a good time to communicate those preferences with your loved ones.
James Schmidt, MD, knows the value of advanced care planning. A hospital medicine physician at Trinity Hospital, Dr. Schmidt leans on family members to make healthcare decisions for a dying parent or spouse. Often, they have a clear sense of what their loved one would want. But in cases in which family members are in doubt or disagree, advanced care planning is the answer.
There are various forms and instruments for expressing one’s wishes for end-of-life care. Two that Schmidt recommends are advance directives and POLST documents.
Advance directives, often called living wills, are written statements that provide a general sense of the types of life-prolonging treatment a person would welcome or reject. They give instructions about any aspect of healthcare and allow people to choose a person to make healthcare decisions for them if they are incapacitated.
A POLST (physician order for life-sustaining treatment) form provides specific medical orders for patients. For example, a POLST might instruct an attending physician to limit interventions and treat reversible conditions only, or provide comfort measures only, or to give full treatment based on a patient’s wishes.
While advance directives are recommended for people of any age, POLST forms are intended for people who may be in their last year of life or have an irreversible life-limiting condition.
“Both are important,” Schmidt said. “Advance directives give a general sense of what treatments an individual prefers, but because they deal with broad issues, there are some gray areas. A POLST provides specific physician orders that address the treatments a patient would like to have in end-of-life circumstances in a document that is accessible to providers.”
In many instances, first responders must quickly assess what kind of treatment someone wants. While an advance directive conveys that information, finding it at a moment’s notice can be difficult. A common instruction for someone facing a life-limiting illness is to complete a POLST form with their provider and attach it to their refrigerator. Then, paramedics responding to a medical emergency will have a quick reference on the care the patient would like to receive.
Too often, people nearing the end of their lives receive unwanted medical treatment, not because medical personnel are eager to provide it, but because – absent a medical directive — caregivers must provide full treatment.
“I tell people to have a discussion with their family members and fill out an advance directive. Then as you get older, have a discussion with your provider about completing a POLST form. That way, if you can’t speak or communicate, your provider, family and friends will have a good idea about what medical treatments you want,” Schmidt said.