Advance Directives: The Guide for Decision Making

By Jenifer Filo, LCSW, Transitions Care Indiana

Discussing your own desires and wishes regarding your medical care will be a valuable tool when or if you are faced with a significant life-changing event.  Advance directives can greatly help your family  or appointed designee. They can eliminate any confusion and disagreements regarding medical care.

Many people think advance directives are only for people who are elderly or suffering from a life-limiting illness. In reality, situations can happen at any age.  Advance directives are the blueprint for your medical care when emergency situations arise.

There are different kinds of Advance Directives:  

Living Will: When creating a living will, it is important to consider your desires of being self-sufficient and independent. A living will is a legal document which will state your wishes when you become incapacitated. They typically cover areas such as resuscitation, ventilation, artificial feeding and comfort care. It is important to think about how you want to be cared for when a crisis arises.  

Medical Power of Attorney: A medical power of attorney allows you to name another person to make medical decisions for you if or when you are unable to do so yourself. The biggest key is not only identifying an agent, but also discussing what your wishes are regarding treatment, interventions and life sustaining measures.                            

Durable Power of Attorney: This allows you to name another person to handle your financial decisions or affairs.  

POST(IN) or POLST(IL)/DNR: This form is a set of medical instructions for health care providers used to honor and respect a patient’s treatment preferences in relation to life sustaining measures, such as CPR, artificial feeding and aggressive vs comfort measures. The patient, power of attorney, or court appointed guardian are allowed to complete this form. This form should be readdressed regularly as conditions change. 

Supporting Care Decision Making

The Transitions’  Symptom Management Care team will discuss advanced care planning with the patient and family. The purpose is to ensure there is a clear understanding of diagnosis, prognosis, treatment options and goals. It is a good opportunity to readdress all advanced care needs when there is any condition change. The Nurse Practitioner and Social Worker will assist and guide the conversation with patients and families to allow a discussion and development of appropriate treatment plan that follows the patients goals. Many times, this is a very difficult conversation for patients to have with their families. 

The Symptom Management Care team’s role is to provide education and support, as well as give the patient and their family the opportunity to ask questions and seek reassurance. It is important to have this conversation with the identified designee or surrogate decision maker along with the patient. During this discussion, the patient’s wishes related to hospitalization, life support and aggressive treatment vs comfort care all should be addressed. Many states have laws in place for when there is not an identified Power of Attorney or agent to assist in identifying the appropriate decision maker. When completing your own advance directives it takes the guesswork out of who would make decisions regarding your health care needs. Your team’s responsibility is to walk this journey with the patient and family.  They also emphasize that having this conversation is a huge gift to their designated agent and family. They will not be making decisions for their loved one, they will already know what the patient would have wanted. They will be their voice when they are unable to speak for themselves.