Taking the Time to Plan Ahead

As we get older, we begin to think about getting our affairs in order. You may have visited an attorney to set-up a will, or made plans for your children should something happen to you or a spouse. But have you considered your options when it comes to advance care planning, potential hospitalization, and what type of care you would like to receive? The options below could give you an idea of how you would like to express your wishes. However, be sure to start with the following:

Talk to your doctor. The best place to start when thinking about advance care planning is with your doctor. He or she can recommend a course of action specific to your individual health needs.

Talk to your family and/or friends. The advance care planning discussion can be uncomfortable, but you and your family will likely be glad that you had it when the need arises. During these discussions, consider who you might want to name as a health care proxy, explained in further detail below.

Put it in writing. All advance care planning directives need to be put into writing. It is advisable to give a copy of each to your doctor, your attorney, and any family or friends you deem appropriate. Keep your own copy in your wallet and somewhere visible in your home, should first responders need to refer to them upon entry.

Update as necessary. Review your directives periodically, and especially when the state of your health changes. If your wishes change, be sure to notify your health care team and family/friends.

Creating a Living Will

A living will is written documentation that services as evidence of your wishes when it comes to your health care. It is an opportune time to consider your values, and what types of treatment you would or would not want, should illness or injury compromise your quality of life. Your living will addresses end-of-life care options, including those pertaining to resuscitation, tube feeding, and comfort care measures.

There is no standard living will form, but your wishes must be documented in writing. At minimum, your living will requires:

• Your name
• Date you created your living will
• Your statement regarding your personal health care wishes
• Your signature
• The signatures and dates of two witnesses
• Statements from the witnesses that you appeared to willingly sign the document

In addition, having your living will notarized is not mandatory, but could be beneficial if you need to seek medical care outside of New York state, and another state requires it.

Naming a Health Care Proxy

In New York state, you are afforded the ability to name a health care proxy. This person is designated by filling out a form that appoints them the decision maker for your care, should you be unable to communicate your wants and needs yourself. There is a significant amount of leeway associated with this form. For example, you can designate your health care proxy as sole decision maker, leaving any and all decisions up to them, or, you can limit which decisions this person can make. The key to ensuring that your wishes are carried out is having an open, frank discussion with the person you intend to name your health care proxy. This person must be over 18 years old, and can be a relative or close friend.

Even if you are in perfect health, it is never a bad idea to name a health care proxy. Your health care proxy can be designated to follow the wishes expressed in your living will. However, if you are suffering from a chronic illness, or could lose decision-making capacity in the near future, you may want to consider filling out a medical orders for life-sustaining treatment (MOLST) form.

The MOLST Form: Who Is It Most Appropriate For?

The MOLST form is a New York State Department of Health (NYSDOH) approved form that is filled out by a physician after a discussion with you about your wishes for care should you be hospitalized. It immediately becomes an order that all health care providers must follow, including hospitals and nursing homes, in addition to community providers, such as emergency medical services (EMS). Unlike a health care proxy, the MOLST form has been approved for use by minors. It should be initiated if you or a minor child are chronically ill, or could die or lose decision-making abilities within the next year. It is a neon pink form, designed to stand out to first responders when they enter your home, and so that it is highly visible in your hospital chart. It follows the patient from home to hospital and back again, if necessary. It should be reviewed periodically, especially as a condition progresses.

The MOLST form contains sections pertaining to: resuscitation, intubation and mechanical ventilation, future hospitalization and transfer, artificially administered fluids and nutrition, antibiotics, and other instructions about treatments not listed. The NYSDOH provides a series of checklists to help health care providers complete the MOLST form based on whether or not an adult has capacity, and also whether or not they have a health care proxy. A checklist and glossary for minor patients is also available.

A Word about Organ and Tissue Donation

When making decisions about care that pertain to end of life, you should consider your position on organ, eye, and tissue donation. There are several reasons for this, including making your wishes about donation known in the aforementioned documents, and also to family and friends. You can register as an organ donor through the New York State Department of Motor Vehicles website.

Again, though they can be difficult, advance care planning discussions will ultimately make an already challenging and emotional time slightly easier for your family and friends if they know your wishes up front. Taking the time to talk to your doctors and decide what is best for you based on your health, preferences, and values, will go a long way in preparing for the unexpected.

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