How to Control Your Future Medical Care

How to Control Your Future Medical Care

Editor’s note: This is the first post in a two-part series that highlights the value of writing clear treatment guidelines to control your future medical care.

What level of intervention is right for you?

The core of your healthcare directive is your instruction for medical intervention. Glib phrases like “just don’t hook me up to any machines” are inadequate. Which machines are objectionable to you? Even the phrase “no heroic measures” is subject to interpretation. What is deemed heroic to you might be very commonplace in standard medical practice.

Make sure your healthcare preferences are honored

Checking the Do Not Resuscitate box on a form is also insufficient. While it certainly addresses one of the most critical decisions, there’s more to consider when preparing for future medical care.

Not all circumstances or treatment options can be anticipated. Nonetheless, you can write treatment guidelines that create guardrails for your care. With well-written instructions, your healthcare agent(s) will understand the boundaries for just how much—or how little—treatment intervention you desire.

Three broad definitions for future medical care are commonly used to establish the level of intervention you desire.

1. Request all life-sustaining treatment.

This is the choice for anyone who wants to extend his or her life for as long as possible. Life-sustaining treatment includes medical treatments, interventions, and procedures that keep a patient alive by taking over or restoring vital bodily function(s). Some treatments address what is medically urgent (acute), such as cardiopulmonary resuscitation (C.P.R.) to keep your heart beating and to ensure you are breathing, which might require mechanical assistance by placing you on a ventilator. Life-sustaining treatment also includes measures to enable you to continue living—that sustain you—such as kidney dialysis, surgery, artificially administered nutrition (food) and hydration (fluids), blood transfusions, administration of antibiotics and other drugs, and other medical procedures. In medical terminology, this is also referred to as “Full Code” and “Full Support.”

2. Request to Allow a Natural Death (A.N.D.)

This is a relatively new medical term, intended to replace “Do Not Resuscitate” or D.N.R. as well as ambiguous phrases such as “no heroic measures” or “I don’t want to be hooked up to machines.” Ruth Wittman-Price, nursing department chair at Francis Marion University, South Carolina, explains: “The phrase ‘Do Not Resuscitate’ signals an intent to withhold or refuse. It says you’re not going to do something. To ‘Allow Natural Death,’ on the other hand, connotes permission.” The tone of permission enables loved ones to more readily accept the dying process. Though not adopted universally, the phrase “Allow Natural Death” is catching on and is embraced by most hospitals.

As the name suggests, A.N.D. shifts the emphasis from pursuing curative treatment or treatment that would interfere with the dying process, to administering comfort care. It is far broader than D.N.R., as it includes more procedures. While approaches might differ slightly by hospital, generally A.N.D. specifies:

  • Do not resuscitate (also referred to as “No Code”).
  • Do not intubate (ventilate; also considered part of “No Code”).
  • Do not administer antibiotics or curative medications.
  • Do not administer artificial nutrition (food) or hydration (fluids).
  • Do not perform kidney dialysis.
  • Do not interfere with the natural dying process.
  • Do not admit to hospital, unless only addressing symptoms and comfort care.
  • Do provide comfort care (note the positive statement). It is important to emphasize that you can still request and should receive comfort care measures even if you want to allow a natural death.

3. Limit the type of care you receive.

The majority of patients or healthcare agents making the decision for the patient choose the middle road. Minimally, most want to receive comfort-care measures while avoiding invasive treatments. Those with dementia may opt out of treatments that could restore them physically, preferring death to the ongoing loss of memory over time.


In an end-of-life situation, most people want limited—but not all possible—medical care. Defining limited care is the key.


It is nearly impossible to anticipate the types of treatments your medical team could recommend. Broad, directional statements are warranted to best govern your future medical care.

Most healthcare directive forms leave a space that is labeled “Instructions for limited care” or something similar. Unless you are medically trained, you might have no idea how to answer that question with meaningful treatment guidelines.

You can limit your care in at least four ways. In the second part of this series, which will post on February 2nd, I will explain each type of limitation and provide concrete examples that demonstrate the limitation principle.

QUESTION: If you or a loved one have written a healthcare directive, would you please share your story and inspire others via social media? Please share this post with your comment.


WORRIED ABOUT DECISIONS FOR MOM OR DAD?

 

You can prepare for the responsibility of serving as the healthcare agent for one or both of your parents.

This FREE guide will help you to prepare for the future possibility of making medical and personal care decisions for your Mom or Dad. Interested?

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Healthcare Agent Preparation Guide

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