What is Advance Care Planning?

Dr. Carla Ainsworth, MD, MPH breaks down advance care planning 101 and steps you can take to start planning for the future.

When you think about the future, you may wonder how much you will be able to control what happens. Yet, there may come a time when you are unable to make your own decisions — perhaps as a result of mental or physical illness that affects your ability to think and speak for yourself.  While no one wants to be in such a situation, there are many benefits to discussing your future health care decisions now, while you are still present and physically capable. This is where advance care planning can play a role.  

What is Advance Care Planning?

Advance care planning is the process of considering and communicating future decisions about your healthcare, especially if you are unable during a medical crisis. It is an all-encompassing term for choices about your life and care - based on your personal values, preferences, and discussions with loved ones - so they can accurately represent your wishes if they have to speak on your behalf. 

Advance Care Planning may include:

• Choosing the individuals you would want to speak for you if you were unable (a healthcare proxy or durable power of attorney)
• Identifying the quality of life and level of independence that is important to you
• Deciding about intensive or invasive treatments that you might not want at the end of your life 
• Completing advance directive documents 

What is an Advance Directive?

Whereas the term advance care planning encompasses the decisions about your personal life and care, advance directives are the documents that preserve those plans. They outline specific decisions about your health if you were to become seriously or critically ill.

You may have seen advance directives regarding:

• Naming a healthcare durable power of attorney
• The use of dialysis or breathing machines
• Organ or tissue donation
• Resuscitation if your heart stopped beating
• Living wills

Living Wills vs. Advance Directives

While living wills and advance directives are often mentioned together, they differ slightly. Advance directives represent a variety of legal documents with instructions about your healthcare; a living will is a specific form of advance directive. 

What healthcare decisions are included in a living will? Living wills usually outline what treatments you would or would not want if you were very ill and unlikely to recover without long-term intervention. Living wills can help address multiple decisions such as:

• Cardiopulmonary resuscitation (CPR)
• Mechanical ventilation
• Tube feeding
• Dialysis
• Organ or tissue donation
• Donating your body (scientific research)

It can be hard to imagine yourself in such a difficult situation. When making these decisions, there can be many considerations. Are you influenced by your values and those of your family?  How might this be informed by your religious or spiritual traditions? How important is it to you to be independent and self-sufficient? What are the potential harms of certain treatments? Thinking about this may generate a lot of questions.  You can always talk to your provider to better understand your options.

What are the Benefits of Advance Care Planning?

Advance care planning and advance directives help make your decisions clear to your loved ones and healthcare proxy. Should you find yourself in a health crisis, advance care planning will help you get the care that you want, and forego the care that you don’t want. By identifying your preferences, you are providing your healthcare team with clear instructions to deliver the best care possible to you consistent with your wishes.

At the same time, advance care planning takes the burden off of your family members to make difficult decisions about your health. Serious illness and healthcare emergencies can weigh heavily on loved ones, family and friends. Through advance care planning, you can help minimize stress and reduce potential conflicts among family members. It is not your proxy’s job to decide what will happen to you, but to represent your voice.  Your instructions will help your loved ones to know that they are honoring your wishes when they speak for you.  

How to Get Started with Advance Care Planning

Now that you understand the basics of advance care planning, what is the best way to get started? 

Outline your wishes

Think about the kind of treatment you would or would not want in a health emergency, or at the end of your life. Talk with your provider about your current health conditions and how they may affect future decisions. Consider bringing a family member with you to participate in the conversation.  If it helps, ask for additional information to understand your options before you solidify them in writing.

This conversation is about you and what is best for you. At the same time, it is important to have your questions answered by your healthcare team, and to have the opportunity to discuss your feelings with your valued family and friends.

Talk with Your Loved Ones

It can be hard to talk about your future health challenges with your family. But having these conversations before something bad happens can create opportunities for mutual understanding and clarification. It can often be a relief to get everyone on the same page.

Think of situations that remind us all that life is short, such as a friend passing away or getting a bad diagnosis. These can be good opportunities to have discussions with your loved ones about your own health and your hopes and wishes for your future care. 

These conversations can sometimes be upsetting. However, they can also help you and your family to be better prepared to handle future health emergencies. Ultimately, these discussions are meant to help you get the care that you want.  Make sure anyone you have designated as your healthcare proxy is aware of your decisions so they can speak confidently on your behalf.  

Define your wishes legally in writing 

Once you have these discussions and decide about your advance directives, the next step is to fill out the legal forms. A lawyer can be helpful, but often does not need to be involved. It will be important to make sure that you have valid forms for your state.

For information and documents related to your state, check out this great list of advance directive resources as well as PREPARE for Your Care. Your healthcare provider can also give you more information about documents specific to your location.  Make sure you keep copies of your documents before submitting them.

Remember that you are not alone. At One Medical Seniors, we work closely with our patients to navigate the complexities of the healthcare system. We help empower patients to make their own health decisions, including discussions around advance care planning.

For those on Medicare, finding the right primary care provider is crucial to productive doctors' appointments, both virtual and in-person.