Advance Care Planning Basics
Maybe you’ve heard the term advance care planning, but you have no idea what it means or what it entails. And when you Google it a lot of information comes up and you’re overwhelmed and give up. I get it, it isn’t easy to navigate alone. My hope is that by providing basic, foundational knowledge you feel empowered to start doing your advance care planning (or to seek assistance in completing it. There’s no shame in asking for help!). So let’s dive in.
Let’s start from the beginning. What is advance care planning?
Advance care planning is a general term used for the process of planning for a time when you may be unable to speak or make decisions for yourself and documenting your wishes regarding your care. Most people associate this with the end of life, but that isn’t the only time that advance care planning may come into play. Consider if you are unconscious after an accident or if something is found during a pre-planned surgery while you’re already under anesthesia. These may not be life-threatening scenarios but may still require some of the information that advance care planning provides. This is one reason you’ll hear me call it advance care planning more often than end-of-life planning.
When people refer to advance care planning, they generally mean the process of completing your advance directives (don’t worry, we’ll get to those in a minute). Advance care planning may also include compiling a document that lists your important account information, passwords, information on how to access important documents, and/or estate planning with documents like a financial power of attorney and Last Will and Testament, Living Trust, etc. The estate planning part is beyond my scope, so I won’t be getting into that information. And the rest falls into what I call “beyond advance care planning” so we aren’t going to get into that in this post.
Why should you care about advance care planning?
Maybe you’re young or healthy or have no significant family history of illness. If so, you probably can’t imagine a scenario where you would need someone to know your wishes because you can’t speak for yourself. Unfortunately, age, health, and family history (or lack thereof) aren’t guarantees that you won’t encounter a scenario where advance directives are needed. Illness can strike a previously healthy person and accidents can happen to any of us at any time. Having these documents completed means that in a scenario where you cannot speak or make decisions for yourself, you have someone designated to speak and advocate for you and you have provided some guiding information. This has many benefits including:
Increasing the likelihood of getting care that is consistent with your wishes and values
Encouraging patient-centered care
Reducing the decisional burden (and associated guilt) that your loved ones may experience
Reducing moral distress among helthcare workers
Improving the bereavement experience of loved ones by reducing stress, anxiety, and depression after a death
Okay, so what are advance directives?
Advance directive is another general/umbrella term that refers to a group of documents. In Arizona, there are four advance directive documents:
Living Will: this lays out what medical care you do/do not want. Templates usually ask this in regards to life-sustaining treatment but if there are other things you don’t want (procedures, surgeries, medications, etc.) you can specify that here. Depending on the template being used, this section may also include organ donation and/or body disposition options (burial, cremation, aquamation, etc.).
Medical Power of Attorney: this designates the person who will make decisions about your medical care. These decisions may include approving/declining procedures, surgeries, medications, etc. Many templates have a section where you can specifically limit the powers of your power of attorney by listing decisions you don’t want them to have the authority to make. Depending on the template used, this section may include organ donation and/or body disposition options.
Mental Health Power of Attorney: this designates the person who will make decisions about your mental health care. This form is very similar to the medical power of attorney and usually also includes a section to limit this power of attorney’s authority if you want to.
Pre-Hospital Medical Directive/DNR/Orange form: this is the only one of the four advance directive documents that requires a signature from a licensed healthcare provider. It is also the only one that must be on orange paper (this is required for it to be legally valid). This form states that in the event that your heart and/or lungs stop, you DO NOT want to be resuscitated, including CPR, intubation or other advanced airway management, ventilation, defibrillation, cardiac medications.
These documents can be found in the different advance care planning templates that are available. In Arizona, our three most commonly used templates are:
Attorney General’s Life Care Planning packet: this contains all four advance directive documents. It does feel more clinical and formal than the other options. It can also be daunting because it comes in a packet with instructions for each section, but at first glance that makes it look like a lot of paperwork to complete.
Thoughtful Conversations: this form is one page, front and back. It’s quick and to the point, but that means you lose some of the specificity that comes with the length of the other two options. This contains all but the orange DNR form, although that form can be added to this if you want it.
Five Wishes: this is the most informal and conversational feeling of the templates. It takes a holistic view and goes beyond your medical wishes to your spiritual and emotional wishes. This contains only the living will and medical power of attorney but is legal in 44 states (whereas the other 2 meet Arizona requirements but may not meet requirements in other states).
What to do once you’ve completed your documents
Once you’ve filled out your chosen template with your wishes, you need to execute it, which means to sign it in front of a notary or witness (who meets the stated criteria, listed below and in each of the templates. In Arizona, it is just as legally valid to sign in front of one witness as it is to sign in front of a notary. In Arizona your witness or notary cannot be:
Under the age of 18
Related to you by blood, marriage, or adoption
Entitled to any part of your estate
Appointed as your power of attorney/agent/proxy
Involved in providing your health care at the time that the document is signed
Once you have executed your documents, you should give copies out. At a minimum, anyone listed as a power of attorney and your primary care provider should all receive copies. If you have additional healthcare providers, it might be a good idea to provide copies to them as well. Additionally, in some cases, you may want to send it out to loved ones, neighbors, property managers, etc. Keep your original copy in a safe but accessible location so it can be easily accessed if needed.
You may also consider registering it. The Arizona state registry recently switched from being managed by the Secretary of State to Health Current. If you are interested in learning how to register, Health Current has a step-by-step guide here. They also have more information on the registry on their website: https://healthcurrent.org/azhdr/
Once you’ve reached this point, you’ve completed the basics of advanced care planning! You should review your documents periodically to ensure they still align with your wishes, but if they do there’s nothing more for you to do with them! If you have questions on something I didn’t cover, please leave a comment or send me an email and I’ll do my best to help!
As always, this post is for information purposes only and is not legal, medical, or financial advice. If you have questions of those nature you should speak to an attorney, medical professional, or financial professional.
