Advanced Care Planning

Who is it for?

Everyone!  Truly.  Although it’s particularly useful for those who are older than 65 and/or who have chronic illness, as these people are more likely to find themselves in circumstances (e.g. unconsciousness or a change in cognitive ability) where they’re unable to choose medical care for themselves.  

What is it?  

• • discussion of/preparation for future medical care–specifically for those hypothetical circumstances where you’re too ill or incapacitated to communicate your wishes directly and where it falls to a trusted other--spouse, child, friend, etc., termed the "healthcare agent"--to make decisions on your behalf

  • it might include completion of one or more of the following documents:

    • Advanced Directives: legal documents describing your wishes for medical care, which go into effect only if you’re incapacitated; include living wills and healthcare powers of attorney.  (The "Five Wishes" form is a legally valid stand-in which offers more--and more detailed--options for medical care.)

      • • Living Will:  legally recognized, although not necessarily legally-binding, it describes which treatments would be welcome/unwelcome under which circumstances and is used to guide your healthcare providers and healthcare agents. 

        • Durable Healthcare Power of Attorney:  legally binding, it names a surrogate decision-maker (termed the "healthcare agent") who has legal standing to determine your healthcare if you’re unable to do so yourself

          • • it is customary to designate one "primary" healthcare agent AND one or more "alternate" agents

            • it is recommended to choose individual(s) who will make decisions as if they were you

    • Physician/Medical Orders for Life Sustaining Treatment (POLST/MOLST):  a medical order, signed by a physician, which other medical providers are obliged to follow, detailing instructions for three categories of care:  resuscitation, hospitalization, and artificial nutrition 

      • • DNR/DNI/DNH (Do Not Resuscitate/Do Not Intubate/Do Not Hospitalize) might be included as part of a POLST, according to your preferences.  If you for resuscitation to be attempted and/or to be intubated and/or hospitalized, then the POLST would reflect those wishes instead

What will the visit(s) will look?

• • we’ll meet, in person or via telehealth, for one or multiple visits, according to your needs and preferences

  • it’s my recommendation that whomever you plan to designate as your healthcare agent(s) attend, as well, so they can understand your values and perspectives and be counted on to make decisions as if they were you

  • we'll use the Five Wishes form as a template for discussing the types of medical decisions you may one day face; I'll offer details about the experience of serious illness/hospitalization/near death/end of life and explain the implications of choosing the various Advanced Directive and POLST selections on the kind of medical care you might receive

  • we'll explore your goals, values, and preferences; what "quality of life" means to you; and what you might be willing to go through--or not go through--for the chance of more time alive

  • during these conversations, which many people find emotionally difficult, I’ll offer heartfelt care, guidance, and support, taking care to proceed at a pace that’s manageable for all parties

  • if you have an illness, we can explore specific scenarios you’ll be more likely to face in the course of that particular illness; if you do not have an illness, we’ll speak in generalities 

  • if you desire, we can complete the forms detailed above

    • • A POLST can be fully completed with no additional steps

      • An Advanced Directive, Five Wishes form, and/or durable Healthcare Power of Attorney can be mostly filled out, however they need to be signed in the presence of a notary (or of two witnesses meeting particular criteria) in order to be legally valid; unfortunately, I am not able to serve as one of the witnesses, given my role as a healthcare provider

  • I charge $150/hour for this service and anticipate taking 1-2 hours, although the pace is something we mutually set