Deciding for Yourself

Communicating Your Healthcare Wishes 

Having a conversation with our loved ones about our end of life wishes can be difficult, but many of us have strong opinions about being kept alive by artificial means when suffering from a terminal illness, permanent brain damage, or advanced dementia. Advance directives are easy to complete and allow loved ones to understand a patient’s wishes, even when he or she is unable to communicate for themselves when the time comes.

The following information and resources may be helpful in learning more: 

HELPING CONVERSATIONS HAPPEN

The Conversation Project: http://theconversationproject.org/
A public campaign to help make it easier to have conversations about end of life wishes. There is a downloadable Starter Kit, which is a type of workbook to help you start thinking about what your wishes are for a variety of decisions having to do with end of life. 

Start the Conversation: http://www.starttheconversationvt.org/  
Resources and ideas on how to begin the conversation and what should be discussed. 

Advance Directives

There are two types of Advance Directives: the Living Will and the Healthcare Power of Attorney. These are legal documents that can be obtained from an attorney, or may be printed from many different online sources. They must be notarized after being filled out. Once notarized they are legal documents, but can be revoked/replaced by the person at any time. Copies are valid and should be supplied to your loved ones, physicians, and healthcare facilities.

  • Living Will: Provides instructions for the future about what life-prolonging measures a person wants or does not want, or wants withdrawn after a certain amount of time.
  • Healthcare Power of Attorney: Also known as healthcare proxy or healthcare surrogate. This allows for a person and alternate(s) to be named to make healthcare decisions for a person if they are unable to communicate their wishes.

NC Bar Association
http://www.ncbar.org/public-resources/a-gift-to-your-family/
Links to copies of Advance Directives along with educational videos and other information. 

Hospice and Palliative Care, Charlotte Region
http://www.hpccr.org/programs-and-services/community-and-professional-education/advance-care-planning

North Carolina Medical Society End of Life Resources
http://www.ncmedsoc.org/advocacy/public-health/end-of-life-resources/

Caring Connections Advance Care Planning Ahead
http://www.caringinfo.org/i4a/pages/index.cfm?pageid=3277
This website offers a lot of information and answers many questions about Advance Directives. 

NC Secretary of State Advance Health Care Directive Registry
http://www.secretary.state.nc.us/ahcdr/
The registry is designed to make individual’s Advance Directive documents available through the website with a unique user ID and password so they are confidential. Completed, witnessed, notarized documents are mailed in with a fee, then a card with the user ID and password are mailed back that can be kept in a wallet. This is useful so that it is always accessible via the internet.

Advance Directives may vary by state, so a good place to start is an online search of the state of residency’s “Bar Association Advance Directives”. Another resource is Caring Connection’s “Download Your State’s Advance Directives” page http://www.caringinfo.org/i4a/pages/index.cfm?pageid=3289

Physician’s Orders for End of Life

In addition to the Advance Directives, there are two Physician’s Orders that can be helpful toward the end of life. These are only available through a health care provider, and must be signed by a physician, a physician assistant, or a nurse practitioner and are generally used only in the case of serious illness or the elderly. Only the original is valid, so copies are not accepted. If someone has one of these, it should be prominently displayed in the home, usually above the bed for someone bed-bound, or on the refrigerator. It should also be transported with the person, because the orders cannot be followed unless the document is present.

The first is a “Do Not Resuscitate” or DNR. In NC it is always printed on goldenrod colored paper and is sometimes referred to as a “goldenrod”. It states that if the person’s heart stops or they stop breathing that resuscitation is not to be attempted. A sample can be viewed at http://www.ncdhhs.gov/dhsr/EMS/pdf/DNR.pdf.

The second order is a newer document called a “Medical Orders for Scope of Treatment” or “MOST” form. It is always printed on hot pink paper. It has sections dealing with cardiopulmonary arrest, medical interventions, antibiotics, and artificial hydration and nutrition. It gives options as to what the patient may or may not want and is signed not only by the healthcare provider, but also by the patient or their representative. A sample can be viewed at http://www.ncdhhs.gov/dhsr/EMS/pdf/ncmostform.pdf