What is Advance Care Planning and Why Do You Need to Understand It Right Now?

If you should become incapacitated due to illness or from an injury, will the people you love know what kind of care you do or do not want? 

Jessica Zan, manager of care coordination for the Advance Care Planning Program at INTEGRIS Health, explains advance care planning this way. “I tell patients ‘this is how to teach me how to love you in this space,’ and that it’s a gift they can give their loved ones, allowing them to focus on grieving,” she says, rather than burdening them with the stress of trying to make the medical decisions they think you would prefer.

Her role at INTEGRIS Health, established in late 2020, is to help break down the barriers around discussing and planning how each person chooses to prepare to die – or, as she says, “live until they die.” She deals with death and people who are actively dying almost daily but feels her natural empathy and upbringing have prepared her. “I’m good in a crisis,” she says. “I was raised by a pastor,” she explains. Death was part of the job. She attended many funerals growing up and watched her family help other families grapple with the impending death of loved ones. She feels that while life-saving medical technology is wonderful, it also has sometimes given us the false impression that every life can be saved, forever.   

“The reason we are in this moment is partly because tools that were designed for saving lives are used for prolonging lives,” she says. Ventilators, for example, were meant to be used temporarily to treat people who would then come off of them and return to health. Today, many people who are placed on a ventilator linger, with no consciousness and no ability to regain it.

Zan’s job at INTEGRIS Health is to help build a culture wherein discussing advance care is a normal part of an annual physical, just a regular part of wellness. She’s committed to making sure each person’s wishes are an easily accessible part of their medical chart. “The medical world has the responsibility to walk with patients in the truth,” she says. She encourages everyone to learn about advance planning for medical care and work on putting a plan in place. 

We are highlighting the importance of advance health care decision-making, an effort that has culminated in the formal designation of April 16 as National Healthcare Decisions Day. Below we share simple definitions that people hear but might not know what they mean.

Advance Care Planning

If you became too ill or injured to tell our doctors what kind of health care you would want to receive, how would they know your preferences? Contrary to what you may think, advance care planning is not just something we need to think about as we age. 

The reality is that a catastrophic illness or injury can strike any person of any age at any time. Without a plan in place for the type of care you would want to receive, you leave your family members or those closest to you to take their best guess and make those decisions for you. 

Learning about the types of decisions that would likely need to be made at the end of life or after an accident allows you to think them through and make decisions that align with your values, faith and personal views – particularly on when/if your life becomes such that you want your doctors to keep you comfortable, but not to intervene or try to slow your death. After considering your preferences, it’s important to let your family, friends and health care providers know what you’d like to have happen, under which circumstances.

Some of the decisions will have to do with use of emergency treatments to attempt to keep you alive, including:

• Use of CPR
• Ventilator use
• Feeding tubes or intravenous (IV) fluids for hydration
• Comfort care at the end of life

Advance Directive

This is a legal document that outlines the medical decisions you’ve made for yourself. It’s a roadmap your family and friends can follow should you be unable to make choices because you’ve been incapacitated. It’s the kind of document that you can revisit and revise as your situation or health changes. An advance directive is a great gift you can give the people who would likely be attempting to make decisions on your behalf under emotionally difficult times. 

Healthcare Proxy

An Advance Directive allows you to designate a health care proxy.  This articulates and formalizes your wish to appoint someone else to make medical decisions if you cannot, ensuring that your medical treatment instructions are carried out. Without a health care proxy, your doctor may provide you with medical treatment that you would have refused if you were able. If you later regain capacity, you will be back in charge of your medical decisions and the health care proxy will have no effect. A health care proxy only takes effect when medical treatment is needed and two doctors determine that you are unable to communicate your preferences about treatment.

Durable Power of Attorney  

A written authorization for one person to represent or act on another person’s behalf in legal matters in business or private affairs. A person who has been given power of attorney would make medical decisions, manage finances and otherwise act in your place. If you become incapacitated, you’ll want to assign durable power of attorney to someone you trust. This is sometimes called a medical power of attorney, or make a clear statement in your power of attorney papers that you wish to also give medical powers.  

Do Not Resuscitate (DNR) Consent Form

Many individuals do not know that cardiopulmonary resuscitation (CPR) has a low rate of survival (some research shows less than 26% survival, and decreasing with advancing age or illness). Some individuals may not desire for resuscitation to be attempted, if their heart stops, or they stop breathing – they prefer to allow natural death. A Do Not Resuscitate consent communicates your wish to allow natural death to healthcare workers. A DNR can be part of your advance directive but is not comprehensive in its instruction.

Comfort Measures

Comfort measures are the medical treatment of a dying person. The natural dying process is not interrupted, however the dying person is given maximum comfort. This includes physical, psychological and spiritual comfort. Treatments that do not aid comfort are halted, like the drawing of blood or needle sticks.

End of Life Care

People who are dying need help in four areas: physical comfort, spiritual comfort, mental or emotional needs and accomplishing practical tasks. The goal of end of life care is comfort and relief of pain and suffering and ensuring a peaceful death while respecting the dying person’s wishes. Each person’s wishes are different. One person may want to know when death is approaching in order to say goodbye  to friends or family. Another may prefer to die at home, and a third may want to die quickly.

You can receive the legal Oklahoma Advanced Directive forms from your doctor, attorney, your hospital, or you can download them here.