Why Advance Care Planning Matters

By: Todd Wills, MD, FAC
Medical Director – Polk HealthCare Plan

Each April, we recognize National Healthcare Decisions Day. This day focuses on discussions about our healthcare wishes with our family, friends and healthcare providers. Most importantly, these discussions help us to focus on what type of healthcare we would like to receive if we no longer have the capacity to express our wishes directly.

Many of us don’t spend a lot of time considering the types of decisions about our health that might be necessary if we face a significant medical event, such as a stroke or a work accident that leaves us incapacitated. This is especially true when we are otherwise young and reasonably healthy. However, the best time to consider your healthcare priorities is when you do not need to make the decision under urgent circumstances. Making decisions about future healthcare in advance is a process called advance care planning.

Advance care planning starts when you consider what your preferences would be if you were to face a significant medical event.

A few questions to ask yourself are:

• If your heart stopped, would you want healthcare providers to work to resuscitate you?
• If you were unable to breathe on your own, would you want healthcare providers to place you on a ventilator (breathing machine) for support?
• If you were unable to feed yourself or eat normally, would you want a feeding tube placed to provide nutrition?
• If your health were to change, would you consider a change in goals from trying to cure disease to trying to ensure comfort?

None of these are easy questions to consider. The answer to each of these questions often changes over the course of our lives. This is why it is so important to have an ongoing discussion with your loved ones and healthcare providers about these preferences and priorities. It is acceptable and even expected that your advance care plans may change over the course of your life. These decisions are deeply personal. The “correct” answers are the ones which align with your priorities.

The Agency for Healthcare Improvement has created a website called The Conversation Project, which provides several guides to help in the advance care planning process. When navigating this process, there are several terms you might encounter. Here are some definitions to help you understand each one:

1. Advance Directives: These are documents that detail your plans regarding future healthcare decisions. These are sometimes drafted formally by a lawyer, but this is not required. The document typically requires signature by witnesses. Sometimes you might be offered the chance to complete advanced directives forms at your primary care provider or at the time you are admitted to a hospital. While advance directives are similar across the country, each state has different expectations for these documents. The National Alliance for Care at Home offers guidance on completing acceptable Florida Advance Directive Forms as well as information on how medical decisions are made when advance directives are not available.

2.Health Care Proxy: This is an individual whom you designate to make healthcare decisions for you if you are unable to speak for yourself. The health care proxy is often a family member, but doesn’t have to be. In choosing a health care proxy, it is important to find an individual who will make decisions on your behalf which reflect your previously outlined goals and values. If you become incapacitated and don’t have a designated health care proxy, decisions about your healthcare may fall to individuals who do not necessarily know your healthcare priorities.

3. Living Will: This is a document that details your specific wishes for the type and extent of care you prefer in different circumstances. A living will is a helpful document for health care proxies if they are unsure of your advance plans. A living will is also helpful to medical providers to outline your treatment goals and limits in cases where you are unable to speak for yourself.

Discussions about advance directives are personal. It is a good idea to set aside scheduled time with your loved ones and healthcare provider to begin advance care planning. Often, these conversations are enlightening and allow us to share values and priorities that we might not have been able to verbalize previously. Set aside a time where you can have a detailed and heartfelt conversation in a comfortable setting. Your primary healthcare provider can also schedule an appointment with you for a focused conversation on your advance care planning.

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