Wellness Series Summary – Advance Care Planning

Speakers: Sarah Ascher, M.S. and Jill Putt, M.S.

Why is this important?

• You can reduce burden on your family and loved ones during a stressful time by talking beforehand and completing documents.
• 75% of Pima County residents surveyed in 2019 said that they thought discussing end-of-life plans with loved ones was important. However,
  • 53% said they rarely or never discuss death or dying with their family and friends.
  • 68% said they had not written down their wishes.
  • 39% said they had not discussed their wishes with anyone.
• Anyone over 18 years old needs an advance directive.

How do I get started?

• Filling out forms is only part of the process.
• Pause, think, talk, write, communicate, and review.
• Consider these areas of your life:
  • Comforting and pleasant memories
    • When I think about the last phase of my life, what matters most?
    • What gives my life meaning and makes life worth living?
  • Important people
    • Who are the important people in my life that I trust to be my decision-making committee?
  • Desires and decisions about lifesaving measures
    • How much information do I want to know?
    • Do I want to try treatments for a period of time? Stop if I am suffering?
  • Funeral plans
    • What alternatives should I consider?
    • Do I even care since I’m not going to be there?
  • You can be as specific as you’d like.
    • Anyone that you would prefer not to be with you at the end?
    • Is there anyone in your life with whom you have unfinished business?
    • Is music important?
    • Is being outside or having a view to outside important to you?
    • Are there religious practices that you would like or not like to incorporate before or after death?

How do I select a person to speak on my behalf in case I need an advocate?

• Who compromises your personal committee of trusted people?
  • Family members
  • Friends
  • Clergy
• Referred to as health care proxy, advocate, representative, agent, or simply your person
• How to choose your health care proxy?
  • https://www.youtube.com/watch?v=iTxv-20ULwQ
• If you do not have a trusted person…
  • Contact an attorney to help you identify someone to serve as your representative.
• What happens if you don’t choose someone to speak on your behalf?
  • In Arizona, health care providers will go to these people in this order for guidance about your medical care and decisions:
    • Your spouse (unless legally separated)
    • Your adult child (if there is more than one adult child, the consent of the majority)
    • Your parent
    • Your domestic partner
    • Your sibling
    • Your close friend

How do I start a conversation about end of life wishes?

• It can be difficult to talk about end of life and easy to ignore.
• Your health care providers may not feel comfortable bringing up the topic either.
• How to start the conversation with loved ones?
  • How to say it:
    • “This is what is most important in my life and for my medical care…”
  • How to break the ice:
    • “I need your help with something.”
    • “Remember how _____ died – was it a ‘good’ death or a ‘hard’ death?”
    • “I was thinking about what happened to _____, and it made me realize…”
    • “Even though I’m okay right now, I’m worried that _____, and I want to be prepared.”
    • “I need to think about the future. Will you help me?”
    • “I just answered some questions about how I want the end of my life to be. I want you to see my answers. And I’m wondering what your answers would be.”

What kind of documents are there and what do I do with them once the planning process has been completed?

• What living will forms are recognized in Arizona?
  • 5 wishes form
  • Attorney generated form
  • Arizona attorney general form
• Documents should be signed, dated, and witnessed or notarized according to state law
• Advance directives document your wishes about your healthcare. These are documents of choice not limitation.
  • You can choose the type or care and the way that this is provided as long as it is legal and ethical.
  • Even if you choose to forego treatment attempts, you will always be given comfort care to address your medical, emotional, social, and spiritual needs.
• You can be assisted in creating advance directives by the following individuals:
  • Attorney
  • Social worker
  • Family and friends
  • Health care providers
• Advance care planning forms include
  • Medical power of attorney
    • This document lets you choose another person to make health care decisions if you can no longer make those decisions for yourself.
    • Unless the document includes specific limits, the agent will have broad authority to make any health care decision that you could normally make for yourself.
  • Mental health care power of attorney
    • This document lets you choose another person to make mental health care decisions if you can no longer make those decisions for yourself.
    • You should have a mental health care power of attorney even if you are not diagnosed with a serious mental illness.
    • It allows your agent to make decisions in case you need behavioral treatment or placement that could be due to a decline, illness, or medication.
  • Living will
    • This is a written statement that expresses your wishes about medical care if you are ever in a terminal condition, a persistent vegetative state, or an irreversible coma. You should talk to your doctor about what these terms mean.
    • This document must be signed and witness or notarized.
  • Do not resuscitate
    • The document informs emergency personnel, outside of a hospital setting, that if you stop breathing or if your heart stops beating, they are not to start cardiopulmonary resuscitation, or use equipment, drugs, or devices to restart your heart or breathing.
  • The following people should be informed about your completed advance directive:
    • Your appointed health care agent – most important
    • Family and loved ones
    • Health care providers
  • Naming a health care agent does not give up your right to make health care decisions.
    • These documents do not go into effect until your physician determines that you are incapable of making your own health care decisions. Up to that point, you will continue to be in control and be able to make any changes to your advance directive that you wish.
  • You may want to leave more than just a document of instructions.
    • Ethical will
      • Non-legal document written to communicate values and wisdom, history, stories, recipes, and love from one generation to another. It preserves who you are and what matters most to you. It’s a way for you to be remembered and to make a real difference. This writing is spiritual in nature.
    • Forever letter
      • Written to make amends, ask for forgiveness, state hard truths, share personal stories, and offer blessings and hope.
    • What do I do with my completed documents?
      • Completed documents should be given to all your health care providers and to your health care proxy.
      • Store your documents in a safe place.
    • Can I change my mind?
      • Yes! Review your documents after these critical life moments.
        • New medical diagnosis
        • Decline in health status
        • After the death of a close friend or loved one especially if named as your health care agent
        • Divorce or relationship status change
        • Every decade
        • A move creating distance between you and your appointed health care agent

Resources:

www.azendoflifecare.org