Advance Care Planning

• Advance Care Planning
• Advance Directives

Advance Care Planning answers the following two questions:

1. If something were to happen to you, like a big stroke or a heart attack, or maybe a terrible car accident, and you could not make your own health care decisions, who should make those decisions for you?

 

2. if it were discovered that you were terminally ill and no matter what was done, you would die, would that person know what your wishes would be? And what if you were in a permanent vegetative state and could be kept alive like that for years, is that what you would want?

 

Seeking the answers should be a process you share with those closest to you. Your decisions may be written using the standard Texas advance directive forms (see below), but this is not required.

Your personal doctor (along with your family, lawyer, hospital, and community clergy) should know of your plans, goals, and decisions. These directions may also include your desire to receive skin, tissue, or organ donation should you ever have the need – as well as your wish to donate should the opportunity ever arise.

Medical care providers and facilities are obligated to honor your treatment decisions.

Hunt Regional Healthcare seeks to support and honor your right to choose your own personal medical treatment decisions at a time when you may be unable to make them for yourself.

Help may be received by contacting our Advance Care Planning facilitator, Melvin Ray, at 903-408-5000. Continuing education opportunities may also be arranged for professional or public groups.

The Advance Care Planning details outlined below are from the Advance Care Planning booklet distributed as a service by Hunt Regional Healthcare.
View the entire document

ADVANCE CARE PLANNING is the process of helping people to understand the importance of preparing for future medical care.

ADVANCE CARE PLANNING means sharing your story.

ADVANCE CARE PLANNING is the process by which an individual considers his or her personal values about the dying process, discusses those values with family or others close to them and health care providers, and completes the documents that record those decisions for the future.

ADVANCE CARE PLANNING involves two basic parts.

• The first is to decide what you want. To do that, you must understand what kinds of situations you may face and what options for care exist.
• The second part of advance care planning is to communicate with others. Tell your family, others close to you, and your health care providers what kind of care you would want in different situations.

Advance Directives

Advance Directives are the documents used to help a person express his or her wishes and values about medical care in case the person cannot, at some future time, speak for him or herself.

In Texas, there are three commonly used documents to record this information. These forms are not required, but are recognized by health care providers.

You may wish to use other documentation which is more detailed, but the Texas directives offer a good starting point.

They are:

• Directive to Physicians and Family or Surrogates (commonly referred to as a Living Will).
• Medical Power of Attorney (formerly known as Durable Power of Attorney for Health Care).
• Out-of-Hospital Do-Not-Resuscitate Order

Advance directives. . .

• Do NOT require a lawyer or a notary public
• Are free
• Require witnessing and, in the case of the Out of Hospital DNR, a physician’s signature
• Take effect only when you are unable to express your wishes for yourself
• Are reversible
  

DIRECTIVE TO PHYSICIANS AND FAMILY OR SURROGATES
(commonly referred to as a Living Will)

The Texas Directive to Physicians and Family or Surrogates (Texas Directive) allows a person to indicate choices about treatment in the event of a terminal or irreversible disease or condition. This document records for your physicians, family, and others what your wishes are if you are unable to speak for yourself.

The Texas Directive specifically allows you to choose whether you would like life sustaining treatments in two situations:

• a terminal condition
• an irreversible condition

Life sustaining treatment is any treatment, procedure, or medicine that doctors believe is maintaining the patient's life. Without it, doctors believe the patient will die.

Examples include:

• Use of life support equipment such as breathing machines and kidney dialysis
• Medications
• Heart pacemakers
• Feeding tubes
• Fluids provided through a vein (artificial nutrition and hydration)
• Blood transfusions

Sometimes medical care, whether it is a treatment, medication, or a procedure such as an operation, is provided to make the patient more comfortable or to prevent or manage pain.

Such medical care is not considered life-sustaining treatment and may be provided to all patients.

Hospice care is providing a “gentle”, natural death by controlling pain and other physical symptoms, and by providing emotional and spiritual support to dying persons and their families. Under the hospice philosophy, death is neither hastened nor postponed, and procedures that seek only to prolong life without relieving pain or suffering are not appropriate.

A terminal condition is an incurable disease, illness, or injury that doctors expect will cause death within about six months even with life-sustaining treatment.

An irreversible condition is a disease, illness, or injury that cannot be cured although it may be treated. Many irreversible conditions will reach an advanced stage when they will also be considered terminal.

It is important to remember that it may no longer be possible to make a person well or return the person to his or her previous state of health or independence. In those situations, treatments or machines that support organ systems may also cause suffering and prolong the dying process. Only you can decide whether or not you would like the goal of your care to be focused on providing comfort rather than delaying a natural death, and if so, at exactly what point.

In your Texas Directive, you have the opportunity to explain your wishes and include additional requests (for example, particular treatments that you do or don't want) and even to appoint a spokesperson to make health care decisions for you (a spokesperson can also be appointed in the Medical Power of Attorney document).

An appointed decision maker cannot over turn your Directive to Physician, other written instructions, or your know wishes and desires – written, verbal, or inferred.

Many people worry that if they complete an advance directive, they will not receive treatment that they want.

It is important to remember that your directives only take effect when certain criteria are met:

• First - you are unable to make your wishes known.
• Second (in case of the Living Will), a doctor has stated in writing that you are in a terminal or irreversible condition.

It is also good to remember that you can change your directives at any time.

printable Directive to Physicians and Family or Surrogates form

MEDICAL POWER OF ATTORNEY
(formerly Durable Power of Attorney for Health Care)

The Medical Power of Attorney (MPA), allows a person to name someone to make decisions in the event that the person is unable to do so. This is important when there is a problem you did not predict and address in your living will.

This document is especially helpful if the person you would choose to make choices for you is not your legal next of kin.

This document is different from a general power of attorney and does not allow the person to make decisions about your money or property. Texas has two powers of attorney - financial and medical - they are not reciprocal, one cannot do the other.

The MPA allows the person you appoint to make specific treatment decisions in accordance with your wishes. In complex and rapidly changing medical situations this can be very important.

Many people fear spending extended periods of time on organ-support equipment in intensive care units when dying. But some would be willing to be put on a breathing machine (for example) for a short period of time (several days perhaps) if there were a good possibility that they could recover to their previous state of health and independence.

Your MPA would allow the person you appoint to evaluate the situation and make decisions that you would make in that specific situation (not terminal or irreversibly ill) without dishonoring your written and known wishes.

Two important points about the person appointed to be your MPA:

• The person you choose must know your wishes, desires, beliefs, and values
• The person you choose must be willing to follow your wishes. If a person tells you he or she couldn’t make the decision to withhold organ-sustaining treatment even if that were your wish, that person should not be your MPA. Health care providers must follow your known wishes.
  

printable Medical Power of Attorney form

OUT-OF-HOSPITAL DO-NOT-RESUSCITATE (DNR) ORDER

The Out of Hospital DNR Order is used most commonly when a person has a life-threatening or terminal illness and does NOT want a 911 emergency resuscitation in the event that he or she dies.

This does not apply in the inpatient hospital setting, but does apply at home, in a nursing home, at a grocery store, in a hospital emergency room, in an outpatient clinic, or in an ambulance leaving the hospital to go home.

Unlike the other two, this directive may be executed by a surrogate for an incompetent patient.

printable Out-Of-Hospital DNR Order form

Two witnesses are required to sign all of your Texas advance directive documents.

One of these witnesses must be someone who is NOT:

• Someone related to you
• A person having a claim to your estate
• The person appointed to be your spokesperson in the document
• Your attending physician or one of the physician’s employees
• A person providing direct care to you or employed in the business office of a health care facility where you are a patient

In addition, a doctor’s signature is required for the Out of Hospital DNR Order form.

This information is provided to comply with the Texas Advance Directive Act and the Federal Patient Self-Determination Act. Complaints may be filed with the Texas Department of Health,
1100 West 49th Street, Austin, Texas 78756 (18002281570).