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Advanced Care Planning

A Living Will, also known as an Advance Directive, lets your wishes be known regarding your medical care and the measures you would want taken to either sustain your life, or discontinue life-saving care, in the event you are unable to make these decisions yourself. By letting your loved ones or caregivers know ahead of time what your final wishes are for your care, it removes a burden from them, and eliminates any guilt they may have by making decisions that you may not have wanted.

  • Advance Care Planning is different for everyone and is largely dependent on a person’s age and individual’s health status.
  • Advance Care Planning should be reviewed regularly and adjusted as necessary depending on the changing circumstances in your life.
  • Advance Care Planning is good for every adult, regardless of age, to do this type of planning, and let others in their life know of their wishes.

It will be necessary to select a health care advocate (also called a representative, health care agent or surrogate) who is a person most familiar with your wishes, and whom you would trust to speak for you if you are unable to do so. It is important to have these wishes in writing, making sure that your healthcare advocate has a written copy. Your healthcare providers should also be given a copy of your written plans to make sure that your wishes are honored. New copies should be given any time you make changes to your plans.

An Arizona Blood and Cancer Specialists’ Palliative Nurse Practitioner is available to discuss your wishes and goals of your care and explain the Advance Care Planning process. Specific details about your healthcare choices and options will be fully explored, including:

⦁ Cardio-Pulmonary Resuscitation (CPR)
⦁ Intubation (Mechanical Breathing)
⦁ Dialysis
⦁ Medication to fight infection or replace a failing bodily function
⦁ Artificial Nutrition and Hydration
⦁ Pain Control and Comfort Care

Terminology

When you are in the process of your Advance Care Planning, these are terms you may hear. It is helpful to understand what each of them is.

Advance Care Planning is an ongoing communication process that identifies an individual’s wishes, values, preferences and goals regarding their future medical care if they lose the capacity to make health care decisions for themselves. A legal document known as an Advance Directive is then created that reflects these decisions and wishes.

There are two different types of advance directives.
⦁ An Instructional Advance Directive allows a person to write down their wishes or instructions regarding treatment when they are terminally ill or permanently unconscious.
⦁ A Power of Attorney for Healthcare is a designative advance directive. It allows a person to designate their agent or surrogate decision-maker should they lose decision-making capacity. They are regulated differently in every state.

Comfort Measures/Comfort Care is medical and supportive care that makes a person comfortable at the end of life by relieving pain and other symptoms. This type of care is not focused on curing or prolonging life.  

Do-Not-Intubate Order (DNI) is written by a physician that communicates a person’s wish to not have a breathing tube at the end of life.

Do-Not-Resuscitate (DNR) Order, Do Not Attempt Resuscitation (DNAR) or Allow Natural Death (AND) are documents signed by a physician indicating that a person does not want medical personnel to perform cardiopulmonary resuscitation (CPR) or other life-support measures to restore breathing and the normal rhythm of the heart. In Arizona, this document must be printed on bright orange paper.

Durable Power of Attorney for Health Care appoints a health care advocate to make medical decisions if a person is unable to do so. 
⦁ In most cases, a power of attorney goes into effect when a physician determines a person is either temporarily or permanently not able to make his or her own decisions.
⦁ If a person regains the ability to make decisions, the health care advocate cannot continue to make the decisions. Some states have specific requirements regarding decisions about life-sustaining medical treatments. 

Palliative is different than Hospice Care. Palliative Care provides support for patients facing debilitating chronic diseases and life-threatening illnesses. It helps a patient improve their quality of life, deal with side effects, reduce their anxiety and depression, and provide effective pain control. Palliative care can be offered at any stage of any illness, while Hospice Care is used during the last stages of life for patients who are ready to discontinue life-prolonging or curative treatments.