The time to think about future healthcare decisions is now
While we don’t think twice about making decisions about the health of our personal finances and investments, it is also important to think about our own healthcare and treatment as we age, and make sure our loved ones know our wishes.
National Healthcare Decisions Day (NHDD), an annual initiative held on April 16, reminds us of the importance of planning, discussing and preparing for future decisions about our medical care in the event we become seriously ill or are unable to communicate our wishes.
“The time to start a conversation about healthcare planning and decisions is when you become an adult and become responsible for your own decisions,” said William Agel, MD, MPH, chief medical officer for Cape Cod Hospital and Cape Cod Healthcare. “When you turn 18, it would be a good time to pick someone for your healthcare proxy.”
Where to Begin with Discussions and Documents
Honoring Choices Massachusetts is a non-profit for consumers in Massachusetts that helps inform and support adults to create a personal care plan for today and over their lifetime. The organization provides toolkits that help start the conversation, explains how to speak with your primary care physician and others on your medical team, as well as providing the documents to complete.
Some of the documents you should include in your planning packet are:
Health Care Proxy: Choose a trusted person who can make healthcare decisions for you if you are unable to make them for yourself. Your agent has the legal power to speak with your physicians about your condition and treatment options. They can also read your medical records and make decisions about your health that align with your goals, values and choices.
In Massachusetts, a spouse, family member or friend does not automatically have the legal authority to make healthcare decisions for you unless they are the appointed healthcare proxy.
A healthcare proxy can be completed by yourself or done with an attorney and submitted by either uploading to your MyChart account, emailing Cape Cod Healthcare's medical records department (cchcmedicalrecords@capecodhealth.org), faxing to 508-790-4548 or bringing the form to your next medical appointment.
Personal Directive (PD) also known as Living Will: Although a Living Will is not legally binding in Massachusetts, it is a helpful tool and an essential part of your care plan and provides you with the opportunity to write down your instructions for care during your recovery from an illness or end-of-life care and treatment decisions. You can change it at any time, as your healthcare needs change over time.
Durable Power of Attorney: A legal document whereby you appoint a person you trust to manage your money, property and financial matters if you become incapacitated or disabled. This document is usually completed with an attorney.
Medical Orders for Life-Sustaining Treatment (MOLST): This document is a medical order for those with a serious illness or frailty. This can be set up after a discussion with your healthcare provider about your medical condition, care goals, priorities and recommended treatment options. You choose the options on the MOLST form that best explain your desired treatment choices. The form is signed by you and your healthcare provider and is used in case of emergency if you cannot speak for yourself.
Comfort Care/Do Not Resuscitate (CC/DNR): This is a medical document that verifies you have a ‘Do Not Resuscitate’ medical order in effect. It states you do not want any medical personnel, including emergency medical services, to attempt to restart your heart and breathing if your heartbeat and breathing stop.
“Making decisions into context is very important,” said Dr. Agel. “Performing cardiopulmonary resuscitation (CPR) on a 19-year-old who is in a car accident and may also need to be put on life support, is likely to be highly successful. But an 85-year-old may not want to go through those treatments that are most often going to be unsuccessful. The documents such as the Do Not Resuscitate order (DNR) on the MOLST form will let the let the hospital staff know what you want and don’t want.”
Things to Think About
Dr. Agel recommends the following:
- Have the conversation early
- Be proactive in the conversation
- Involve your primary care provider
- Reassess on a regular basis
“We all look at our bank accounts and financial statements on a regular basis,” he said. “We need to look at our healthcare decisions on a regular basis. Anytime something changes, such as a decade birthday, you’re diagnosed with high blood pressure, or a new medical diagnoses, are good times to reassess your plans and decisions.”
