As a person with cancer or a caregiver, it’s important to be prepared for the unexpected. One way to prepare is through advance care planning, which involves deciding the kind of medical care you want if you aren’t able to make decisions for yourself. This can ensure your preferences are respected and your loved ones are not left with difficult decisions during a stressful time.
Advance care planning may feel overwhelming, but understanding the different advance care terms can help make the process a little bit easier. This blog post gives an overview of these terms.
By the end of this post, you’ll have a better understanding of the types of advance directives that are available and be able to make informed decisions about your future health care. So let’s dive in and explore these important advance care planning terms.
Living Will
A living will, also known as an advance directive or advance care directives, outlines the kind of care you wish to receive if you can’t communicate your preferences. It typically states what kind of medical treatment you do or do not want, such as life-sustaining measures, a feeding tube, ventilators, and CPR. It can also include your wishes around pain management and end of life care.
A living will is different from a last will and testament, which deals with your property and assets after you die. It is important to note that a living will only goes into effect when you are unable to make decisions for yourself, and it can be changed or revoked at any time as long as you are still capable of making your own decisions.
In some states, a living will may need to be signed by witnesses or notarized in order to be legally binding.
It’s important to keep a copy of your living will in a safe and accessible place, and to make sure your healthcare providers and loved ones have a copy as well. Your medical facility may scan a copy into your electronic health record so that it is always available. Just be sure to provide a new copy if you make any changes.
Health Care Proxy
A health care proxy, also known as a durable power of attorney for health care, health care power of attorney, or medical power of attorney (MPOA) designates someone to make medical decisions on your behalf if you cannot. This person is often referred to as a “health care agent” or “health care surrogate.”
Unlike a living will, a health care proxy gives your agent the authority to make decisions based on your overall values and wishes. This can include decisions about life-sustaining treatments, pain management, and other medical interventions.
It’s important to choose someone who you trust and who understands your values and preferences. Substitute decision-makers should make decisions based on what they think you would want. You should discuss your wishes with your health care agent in advance and make sure they are comfortable making decisions on your behalf.
DNR (Do Not Resuscitate) Order
A DNR order is a medical order that instructs healthcare providers not to perform CPR (cardiopulmonary resuscitation) if your heart stops beating or your breathing stops while you are in a medical facility. This order can be included in a living will.
A DNR order can be included in your medical records and should be discussed with your healthcare team and family members. It’s important to note that a DNR order does not mean that all medical treatments will be stopped, only that CPR will not be performed.
A non-hospital DNR order states that you do not want CPR to be performed during emergency care in your home or anywhere outside of a medical facility.
You can have both types orders completed to make sure your personal preferences of not receiving CPR is followed no matter where you are in case of a medical emergency. But it’s important that you carry a copy of a valid DNR order with you at all times to make sure emergency service providers know and follow your request.
DNI (Do Not Intubate) Order
A DNI order is similar to a DNR order – it is a medical order that instructs your medical staff not to intubate if you go into cardiac arrest or are unable to breathe on your own.
Endotracheal intubation is the process of placing a tube down your nose or mouth and into your airway to help you breathe. The tube is connected to a mechanical ventilation machine that breathes for you. A DNI order can also be included in a living will.
A DNI order should be included in your medical records and discussed with your healthcare team along with your family members and/or health care representative or proxy. It is important to remember that a DNI order does not mean that all life-prolonging treatment and medical treatments will be stopped, only that you will not be intubated.
Last Will
A last will, also known as a “last will and testament,” is a legal document that outlines your wishes for how your property and assets will be distributed after your death. It allows you to name an executor to manage your estate and distribute your property according to your wishes. In a last will you can also name guardians for any minor children.
Creating a last will is important for everyone, regardless of age or health status. It ensures that your belongings are distributed according to your wishes and can help avoid fights among family members. It’s important to update your will periodically to reflect any changes in your life circumstances, such as marriage, divorce, the birth or adoption of children, etc.
Be sure to store your will in a safe location and to inform your loved ones and executor where it is located. You may want to work with a lawyer to make sure your will follows state laws and is properly executed.
While a last will can provide peace of mind about what will happen to your belongings after you’re gone, it does not address other end-of-life issues, such as medical treatment and end-of-life care. For these issues, other documents, such as a living will or healthcare proxy, may be necessary.
Depending on your financial and personal circumstances, you may also want to consider other estate planning documents like trusts. Talk to an estate planning attorney to determine what is best for your specific situation.
Power of Attorney
A power of attorney (POA) is a legal document that gives someone else the authority to act on your behalf in legal and financial matters. There are different types of POA, but in general, they allow someone you trust to make decisions and take actions for you when you cannot.
For example, if your treatment is too intense and you can’t manage your finances, you can grant someone power of attorney to pay bills, manage investments, and handle other financial matters.
It’s important to choose someone you trust and communicate your expectations clearly to them. You should also review and update your power of attorney periodically to ensure that it reflects your current needs and wishes.
A power of attorney can also be used for legal matters such as signing contracts and making legal decisions. You can choose different people to serve as a legal POA and a financial POA.
It’s important to make sure that your power of attorney documents are properly executed and enforceable in your state. This may involve having them notarized or witnessed by appropriate people.
Medical Orders
While documents like a living will, POA, health care proxy and last will are advance care planning documents that are legally binding, there is another type of document that is called an actionable medical order. This means that health care professionals are required to follow the instructions in these documents.
Another difference is that these forms are completed with your doctor and entered into your medical record, versus the other documents that are completed on your own or with a lawyer and then provided to your medical team.
POLST/MOST
POLST (Physician Orders for Life-Sustaining Treatment) or MOST (Medical Orders for Scope of Treatment) are forms that contain the same information but go by different names depending on the state you live in. This is a document for seriously ill patients or those that are nearing the end of life.
The MOST or POLST form is completed with your doctor by yourself or a health care proxy. This form covers instructions on whether you want CPR, intubation, artificial nutrition or hydration, antibiotics, or to receive comfort care (also called palliative care) only.
Some of this same information is covered in a living will. But having the information in a POLST or MOST means that health care providers must follow what the form says.
Conclusion
Understanding advance care terms is an important step for people with cancer and their caregivers in planning for their future healthcare needs.
The primary goal of advance care planning is to record your wishes. These documents let you decide what you want and how you want your quality of life to look in case you cannot verbally state those wishes in the moment.
Completion of an advance directive is a voluntary process that lets you specify your future care decisions and end of life decisions. These legal documents provide guidance to healthcare providers, family members and close friends, ensuring that your healthcare wishes are respected and carried out.
It might seem overwhelming to make these decisions. But it’s important to remember that they exist to provide you peace of mind and make sure that your personal values and requests are respected. Open and honest conversations with your loved ones and your healthcare team can help make the process easier and make sure everyone understands what you want done for your future medical care.
Free Resource!
Want an easy way to keep track of the advance care planning documents you’ve completed and always know where they’re located? Use the Advance Care Planning Document Tracker, found in our FREE resource library. It’s simple and easy to use, and you can update it any time you need.
