Friday, April 12, 2013

Planning for the future: advance directive Q&A

What would happen if you or a loved one became sick or injured and were unable to express your health care wishes? In recognition of National Healthcare Decisions Day on April 16, Cynthia
LaSala, MS, RN, clinical nurse specialist and adviser to the MGH Patient Care Services Ethics in Clinical Practice Committee, discusses the importance of having an advance directive to help convey your health care wishes in a clear, concise manner.

What is advance care planning?
Advance care planning is the process of making decisions about your medical care treatment preferences should you become unable to speak for yourself. This plan is put into a document called an advance directive.

How does an advance directive work?
An advance directive is a legal document that describes the type of medical care you want to receive if you become unable to make medical decisions yourself. It only goes into effect when you are unable to speak for yourself. You can change it at anytime.

Who should have an advance directive?
Everyone. Advance care planning is not just for older adults or those with a serious illness. The best time to complete an advance directive is when you are healthy and not physically or emotionally affected by an acute illness or disease. It is very important to talk with loved ones about the type of medical care you would want to receive in the event you are unable to make health care decisions for yourself. Having
an advance directive in place – which, again, you can change at anytime – makes your wishes known.

What are the different types of advance directives?
The most common advance directive used at the MGH is the Massachusetts Health Care Proxy form. This is a legal document that names a person you trust as your health care agent. This person will have the authority to make health care decisions for you if you are unable to speak for yourself. Another type is a living will, which details what type of treatment you want or don’t want when you are seriously ill. In Massachusetts living wills are not legally binding. However, they may be used together with a Massachusetts Health Care Proxy form to guide treatment. Remember to check if the type of advance directive you have is legally acceptable in whatever state or country you reside both now and in the future.

Where can I get a health care proxy form and/or living will?
The Maxwell and Eleanor Blum Patient and Family Learning Center in White 110 has Massachusetts Health Care Proxy Forms as well as another form known as “Five Wishes” for children, teenagers and adults. This form includes a section where you can designate who you would like as your health care agent. Massachusetts is one of about 42 states in the U.S. that legally recognizes the “Five Wishes” document as an advance directive. Remember to keep the original copy of any advance directive document you complete and provide copies to your health care agent, health care provider and anyone else with whom you feel it would be important to share this information.

What conversations do I need to have before and after filling out an advance directive?
To ensure that your wishes are carried out, you need to make sure your health care agent knows the type of care you would like to receive and respects your values and beliefs, even if they differ from those of the agent. Share your wishes with loved ones as well, but take the time to select someone else to serve as your health care agent who will honor your wishes and be able to speak for you should you be unable to do so yourself.

Where can I learn more?
In honor of National Healthcare Decisions Day on April 16, the MGH will host information tables about advance care planning from 8 am to 3 pm in the White Corridor and Wang Lobby. There will also be a presentation, “Understanding Advance Care Directives,” with speaker Carolyn LaMonica, RN, at noon in the Blum Center.

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