Making end-of-life care decisions early can ease your mind and decrease stress on your family.
There may come a time when you can't tell the health care team what you want. When that happens, would you prefer to have your doctor and family make decisions? Or would you rather make decisions early, so your wishes will be known and can be followed when the time comes? If not planned far ahead of time, the end-of-life decisions must be made by someone other than you.
Planning ahead for end-of-life care helps with the following:
- Makes sure your doctors and family know what your wishes are.
- Allows you to refuse the use of treatments.
- Decreases the emotional stress on your family, who would have to make decisions if you aren't able to.
- Reduces the cost of care, if you choose not to receive life-saving procedures.
- Eases your mind to have these decisions already made.
You can make your wishes known with an advance directive.
Advance directives are documents that state what your wishes are for certain medical treatments when you can no longer communicate those wishes.
Advance directive is the general term for different types of documents that state what your wishes are for certain medical treatments when you can no longer tell those wishes to your caregivers. In addition to decisions about relieving symptoms at the end of life, it is also helpful to decide if and when you want certain treatments to stop. Advance directives make sure your wishes about treatments and life-saving procedures to keep you alive are known ahead of time. Without knowing your wishes, doctors will do everything medically possible to keep you alive, such as cardiopulmonary resuscitation (CPR) and the use of a ventilator (breathing machine).
Each state has its own laws for advance directives. Make sure your advance directives follow the laws of the state where you live and are being treated. State-specific advance directives can be downloaded from the Caring Connections section of the National Hospice and Palliative Care Organization website.
The following are types of documents that communicate your wishes in advance:
- Living will: A legal document that states whether you want certain life-saving medical treatments to be used or not used under certain circumstances. Some of the treatments covered by a living will include CPR, use of a ventilator (breathing machine), and tube-feeding.
- Health care proxy (HCP): A document in which you choose a person (called a proxy) to make medical decisions if you become unable to do so. It's important that your proxy knows your values and wishes, so that he or she can make the decisions you would make if you were able. You do not have to state specific decisions about individual treatments in the document, just state that the proxy will make medical decisions for you. HCP is also known as durable power of attorney for health care (DPOAHC) or medical power of attorney (MPOA).
- Do-Not-Resuscitate (DNR) order: A document that tells medical staff in the hospital not to do cardiopulmonary resuscitation (CPR) if your heart or breathing stops. (See the Cardiopulmonary resuscitation (CPR) section, above, for more information.) A DNR order is a decision only about CPR. It does not affect other treatments that may be used to keep you alive, such as medicine or food.
- Out-of-hospital DNR order: A document that tells emergency medical workers outside of a hospital that you do not wish to have CPR or other types of resuscitation. Each state has its own rules for a legal out-of-hospital DNR order, but it is usually signed by the patient, a witness, and the doctor. It's best to have several copies so one can quickly be given to emergency medical workers when needed.
- Do-Not-Intubate (DNI) order: A document that tells medical staff in a hospital or nursing facility that you do not wish to have a breathing tube inserted and to be put on a ventilator (breathing machine).
- Physician Orders for Life-Sustaining Treatment (POLST): A form that states what kind of medical treatment you want toward the end of your life. It is signed by you and your doctor.
- Medical Orders for Life-Sustaining Treatment (MOLST): A form that states the care you would like to receive if you are not able to communicate. This care includes CPR, intubation (breathing tubes), and other life-saving procedures. Under current law, the information in a MOLST form must be followed both in the home and hospital by all medical staff, including emergency medical workers.
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All your caregivers need to have copies of your advance directives.
Give copies of your advance directives to your doctors, caregivers, and family members. Advance directives need to move with you. If your doctors or your place of care changes, copies of your advance directives need to be given to your new caregivers. This will make sure that your wishes are known through all cancer stages and places of care.
You can change or cancel an advance directive at any time.