Controlling Your Future Medical Care: Part 2

Controlling Your Future Medical Care: Part 2

Control Medical Care

These 6 treatment guidelines can help you to express your preferences for future medical care.

Editor’s note: This is the second of a two part series offered to help you and those you love learn how to control your future medical care by clearly communication your wishes.

Planning for future healthcare decisions requires more than checking a box on a form. Part 1 of this post series conveyed three broad definitions for future medical care that are commonly used to establish the level of intervention you desire. Through your healthcare directive, you can request to:

  1. Receive all life-sustaining treatment to extend your life as long as possible.
  2. Allow a natural death, by refusing a range of treatments.
  3. Limit the care you receive according to your written guidelines.

Here’s a word of caution. Please be judicious about healthcare instructions that are exceedingly restrictive, allowing for no care. Similarly, be cautious about requesting all possible care if you have any concerns about being hooked up to machines for months or even years, if that should be required.

Studies show the majority of people would prefer to die at home, rather than receiving invasive treatment and being confined to a hospital bed. In fact, more than 80 percent of patients with chronic diseases say they want to avoid hospitalization and intensive care when they are dying. Achieving that goal requires planning, particularly if you want to limit your care.

The art of describing your treatment limits lies in creating guardrails that establish boundaries for your care, while also leaving room for decision-makers to navigate. Not every medical circumstance can be anticipated. Healthcare agents might be required to interpret your instructions to honor the spirit of your wishes.

How should you define the limits of your care?

If you are like most people, you want to limit your care. You don’t want to receive all possible treatments to the bitter end. However, you don’t want no care. Describing middle-of-the-road choices requires careful consideration. Where should you start?

A conversation with your physician is strongly advised to help you articulate what is right for you. I highly recommend investing time to learn about life-sustaining treatment choices  before writing any limiting guidelines for your future medical care.

The following limitations for medical care can create a framework for decisions. You can ask to limit your care according to:

1. Duration of treatment
You can request that you receive treatment for only a trial period. That may make it easier for your loved ones and medical team to withdraw treatment if you are not responding. Knowing you’ve given permission—and have even asked—to have treatment withheld or withdrawn if you are not responding, can reduce the anguish for those making this decision on your behalf.

For example: Being willing to be placed on a ventilator for a trial period (days or weeks) in an effort to give your body time to recover from pneumonia, yet being unwilling to remain on a ventilator for months.

2. Types of Condition
You can ask to receive treatment only for a reversible condition. A few examples include: skin infection, bladder infection, bronchitis, uncomplicated pneumonia, bacterial pharyngitis, bacterial sinusitis, and uncomplicated eye infection (pink eye).

For example: Receiving antibiotics for several days in an effort to address a bladder infection, even when diagnosed with terminal cancer, and requesting no resuscitation or additional chemotherapy.

3. Purpose for treatment
You can state that treatment should be directed at prolonging a meaningful quality of life, as you have defined it, versus prolonging the dying process.

For example: Accepting dialysis while you are still able to recognize loved ones in spite of dementia, yet choosing to have treatment withheld or withdrawn if you can no longer recognize those you hold dear.

4. Exclusions
You may specify any number of exclusions due to personal beliefs, values and even preferences.

For example: Common exclusions include C.P.R., intubation (ventilation), dialysis, antibiotics for life-threatening infection (such as pneumonia), electroconvulsive therapy, psychotropic drugs, pregnancy termination, sterilization, amputation of any limbs, blood transfusion for religious reasons, and more. Speak with your doctor about what exclusions are appropriate to meet your preferences and personal beliefs for end-of-life care.

5. Alternatives
You can specify alternative treatments.

For example: You could state that you do not want tubes put in your nose or throat for breathing, but that you are willing to receive external breathing assistance, with a tightly fitting oxygen mask. This is called “positive airway pressure.” Or, you can state a preference for alternative pain management, such as acupuncture or other non-traditional therapies.

6. Emotional and spiritual care
The end-of-life journey is physical, emotional, and spiritual. Tell your loved ones what kind of support will give you comfort. Communicating your needs for emotional and spiritual care is instrumental in assuring a graceful journey.

For example: My healthcare directive expresses my desire for prayer from my congregation, a visit from my pastor, and praise and worship music playing softly in my room.

What Values Should Frame the Decisions?

Including statements about your values and beliefs in your healthcare directives will offer much-needed support to your healthcare agents and medical team. Articulating the why for each guideline can provide tremendous clarity and support regarding the basis for each guideline. Consider incorporating these why statements with each care guideline.


Express limits for your future medical care with statements that can guide decisions in multiple circumstances.


Control what you can.

Might I urge you to resist the convenience of merely checking a “DNR” box? With thoughtfully written treatment guidelines, you can direct the medical, emotional and spiritual care you receive, even if you are unable to speak for yourself. While none of us knows what may befall us, developing clear treatment guidelines for our future medical care allows each of us to define what we can control.

Question: Are there other types of guidelines you or a loved one have expressed for end-of-life care that you can share with others? Please take the conversation to social media by sharing 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?

Click here to download your copy

 

Healthcare Agent Preparation Guide

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