Did you know that National Healthcare Decisions Day (NHDD) is April 16? NHDD was first designated in 2008 with the goal of educating and empowering the public, as well as healthcare providers about how important advance care planning is. If you have had an overnight stay in a hospital recently, you may have been asked your wishes regarding heroic measures if your heart were to stop or you were to stop breathing on your own. A Do Not Resuscitate wrist band may have placed upon your wrist. You may have heard the words, “full code.” These are all terms used by healthcare professionals to appropriately communicate your wishes if you were to need heroic measures. For some of you, this is hard to think about, and even harder to talk about. For others, you’ve thought about it and already made your decisions so this is an easy question to answer. Whichever side of the coin you’re on, it is most important that those decisions are made and shared with your loved ones, and your healthcare providers.
Starting these conversations may be difficult. There are some great resources available online to aid in talking with your family about your wishes. They are listed at the end of this article. After discussing them and deciding what you would want or not want in your health care, it is best to get your wishes in writing. Creating an Advanced Healthcare Directive is a simple way to write out your plans so your care providers know, even if you are not able to speak for yourself. You can change these plans at any time, but while in place they do offer some guidance for your family and healthcare providers. Once you have created your Directive, give copies to the health care facilities where you receive care. They are then placed on your medical file for future reference. It is a good idea to keep a copy in your wallet or purse too. You may also wish to share these forms with your family or close friends so they are also aware of your wishes.
Another way to express your wishes is through a Provider Orders for Life-Sustaining Treatment (POLST) form. The POLST is an optional part of every hospital stay where you can express your wishes and discuss your options with your healthcare team. Once a form is filled out, it stays with you and can be reviewed and used from hospital stay to hospital stay. If you have one of these forms, they are printed on bright green paper, you are encouraged to leave it in a visible place in your home. If you ever need the ambulance to
bring your form with you to the facility so your wishes are met upon your arrival at the facility. A POLST must be signed by your primary care provider, and it can be changed or rescinded at any time. If at any time changes are made, the new document will need to be signed by the provider and you will need to distribute the updated copy.
There are a few main points to consider when having these conversations with your loved ones.
Who would you like to make decisions for you regarding your healthcare if you were ever unable to voice your opinions? You can appoint a medical power of attorney that is to act on your behalf in any situation when you are not able to decide for yourself. If there is no one designated, next of kin is usually consulted for these decisions. To appoint someone as your power of attorney (POA) you must work with a lawyer. You do have the ability to appoint one person as your durable POA, or appoint a limited POA for either finances or medical decisions. This would be helpful in situations where, for example, you’d want a spouse making your medical decisions and a child managing the household finances. Your attorney can help you better understand the differences and guide you to the decision that works best for you and your family.
Do you want CPR? CPR, or cardiopulmonary resuscitation, is performed when your heart stops beating. Another person pushes hard on your chest to compress your heart, helping to circulate blood through your body until your heartbeat returns. CPR alone usually does not restart the heart, but it does keep your brain and other organs oxygenated which is vital to maintain your independence afterward. Using a defibrillator and medications are the best ways to restore a regular heartbeat. For CPR to be effective at preserving organs, it must be started shortly after you collapse. That is not the time for your family to be wondering or trying to decide if you’d want this or not.
Do you want to be intubated? Intubation is the process of placing a tube into your trachea (windpipe) to help you breathe. If you have ever been under general anesthesia (“knocked out”) for surgery, you have probably been intubated. Generally, if you are unable to breathe you are intubated and then hooked up to a machine called a ventilator. This machine helps you to breathe when you are unable to effectively do so on your own. In cases like surgery, people are only ventilated for a few hours when the sedation is heavy. COPD, ALS, pneumonia or other lung infections can also warrant the need for a ventilator. In situations where you’re intubated due to illness, you may be on a ventilator for days, weeks, or months. In some cases, a person is never able to breathe independently again so they would live on the ventilator. Depending on the quality of life you would prefer the idea of having a tube down your throat, not being able to talk and maybe never being able to live without a machine does not sound appealing.
There are a few other topics that could also be addressed. Deciding if you’d like IV antibiotics for infections and or to have a feeding tube placed can also be defined in your directive. Placing a feeding tube can indeed get you through some recovery time after an injury/illness that prevents you from swallowing. It can also provide life-long nutrition if you are never able to eat again, each situation is different so it’s important to think about short-term treatments versus sustaining life. You could specify the amount of time you’d want a feeding tube, or how long you’d want to be intubated before withdrawing cares. It is all up to you. These are decisions only you can make and they certainly require a lot of thought.
You get to choose how and what cares you’d like to receive that best meet your ideal quality of life. Having made these decisions and communicated them with your family prevents them from wondering what you’d want if you were ever unable to share your wishes due to illness or injury. If you haven’t already talked this over, please do so now. If you have, please provide copies of your decisions to the facilities where you receive care. Make it a goal to have made those decisions and encouraged your loved ones to have done the same before National Healthcare Decision Day on April 16. Thank you for having these hard conversations and thank you for continuing to be the heart of BSMC.
https://www.theconversationproject.org/
http://www.lastingmatters.com/
https://www.deathbydesign.com/
https://prepareforyourcare.org/index.php/welcome
https://www.aarp.org/caregiving/basics/?migration=rdrct
https://www.nhpco.org/patients-and-caregivers/advance-care-planning/
