18005 Introduction to Advance Care Planning

Introduction to Advance Care Planning

You always have a say in the healthcare you receive and it’s important for you to make a plan in case you have a sudden accident or illness that leaves you unable to speak for yourself. You can’t plan for everything, but you can decide who you trust to make those healthcare decisions for you when you are unable. See “Things to Consider When Naming a Healthcare Decision Maker.”

Your healthcare decision maker should make the same decisions for you that you would make for yourself so it’s important to talk with your healthcare decision maker about what matters most to you. Doing this gives you power over your healthcare decisions even if you lose the ability to speak for yourself.  See “What Does your Healthcare Decision Maker Need to Know?”

Things to Consider When Naming a Healthcare Decision Maker

The person you name as your healthcare decision maker should be someone close to you who can:

• Speak for you if you can’t speak for yourself
• Talk with you now about the kinds of decisions you want to be made if you can’t make decisions for yourself
• Follow your decisions
• Think and communicate clearly in a stressful situation
• Make sure your loved ones and healthcare team understand your decisions

In Virginia, if you do not name a healthcare decision maker in a legal document and you do not have a court-appointed guardian, your legal next of kin will be asked to make decisions for you in the following order:

1. Spouse (even if you are separated unless a divorce action has been filed with the court)
2. Adult children (all your children must agree)
3. Parents
4. Adult siblings (all your siblings must agree)
5. Other blood relatives (aunts/uncles; nieces/nephews; cousins, etc.)

Appointing a HealthCare Decision Maker 

You must complete an advance directive to appoint someone as your healthcare decision maker. Once appointed, the healthcare decision maker becomes your healthcare agent. If a trusted person has not been appointed as your healthcare agent in an advance directive, that person may have no legal authority to make healthcare decisions for you.

You can find information about completing an advance directive on the UVA Health website:

https://www.uvahealth.com/patients-and-visitors/advance-directive

What Does Your Healthcare Decision Maker Need to Know?

Once you decide on a healthcare decision maker, it’s time to start the conversation. Here are some helpful ways to begin:

• “My doctor talked to me” or “I’ve been thinking” about advance care planning recently. I realized I need to appoint someone I trust to make healthcare decisions for me if I can’t make them for myself. Would you be willing to talk with me about this? 
• After seeing what happened when [a friend/family member] became ill, I realized how important it is to choose someone to make healthcare decisions. Would you be willing to talk with me about the kind of care I would want if I ever got that sick? 
• I hope this never happens, but if I became too sick or injured to make my own medical decisions, I would want someone I trust to speak for me. Would you consider being that person? I'd like to talk about what that would involve.
• Have you ever thought about who would make medical decisions for you if you became really sick or were in an accident and couldn't make decisions for yourself?

Your healthcare decision maker should make the same decisions for you that you would make for yourself so it’s important to talk with your decision maker about what matters most to you if you are seriously ill.  You may want every medical treatment possible when those treatments will lead to a full recovery. But if a full recovery becomes very unlikely and/or when treatments become too difficult, you may want to shift care to focus on pain relief, symptom control and quality of life. Once someone agrees to be your healthcare agent, have that person ask you the following questions. You can describe what a meaningful recovery looks like to you and circumstances when you would want to focus on quality rather than quantity of life.

• What experiences have you had with people who are seriously ill and what did you learn from those experiences? 
• What brings your life meaning? 
• What are you willing — or not willing — to go through to live longer?
• What level of physical loss of function would you be willing to live with in exchange for more time?
• What level of mental loss of function would you be willing to live with in exchange for more time?
• What abilities are so important to you that you can’t imagine living without them? 
• What are your biggest fears or worries when it comes to your health?
• What matters most if you only have weeks or months to live?
• Under what circumstances might you choose to have your care focus on comfort rather than on living longer?