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Plan ahead

What you need to know about advance care planning

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It can happen to anyone at any time. One day you are in perfect health, the next you are in the intensive care unit. With family and loved ones gathering at the hospital, the inevitable questions arise: What happens if you can't make decisions about your care? Who should make decisions on your behalf and how will they know what you would want? These are just some of the questions that could be avoided through advance care planning. Dr. Pravinsagar Mehta, a Winnipeg family physician, recently took time out to explain why advance care planning is important.

What is advance care planning and why is it important?

Advance care planning is a term used to describe the process of thinking about what is important to you in your care and treatment in the event that you cannot speak for yourself. You need to talk about it with those that are important to you. Make sure they know what you want and then share it by writing it down.

We all have an opportunity to prepare, plan, execute and follow up on all aspects of our lives to be successful, in wealth and in health. Most of us take health for granted. This is particularly true when one is young, full of vitality and has a false sense of security. But whether you are young or old, accidents and illness may put a damper on hopes and dreams, and shock even robust individuals in the prime of life.

Most of us have close family and friends that we can confide in and trust to advocate for us if we are unable to do so due to injury or illness. Advance care planning requires serious thought about how you would want to be treated under different situations if you were not able to advocate for yourself. It is important to express these wishes in advance to your close family, confidantes and health-care providers, so you receive the quality of care you deserve and continue to enjoy a good quality of life consistent with your future plans.

What is a Health Care Directive?

A Health Care Directive is a document crafted by you with help from your next of kin or health-care provider that spells out your treatment wishes in detail when there is hope that the outcome will be favourable, and reject those that may be futile, inappropriate and end with "decreased quality of life." The wishes expressed in your Health Care Directive are legally binding on your family, friends and health-care providers, unless they are not consistent with accepted health-care practices.

What are the advantages of having a Health Care Directive? Have you heard of examples where a Health Care Directive has been used?

My nephew suffered from an inflammatory muscle disease known as progressive inclusion body polymyositis. He was a brilliant lawyer and a kind human being. His prognosis was poor and he deteriorated as predicted by his wonderful team of care providers. As his disease progressed, he required increasing assistance with all his basic activities of daily life, and was placed in a personal care home. He understood that he would not be able to swallow or breathe on his own as the muscles weakened. He set up a Health Care Directive with assistance from his family, attending physician and his team of health-care providers as he did not want to be put on a ventilator or transferred to an acute care facility for intravenous fluids or antibiotics. When the time was right, he had a peaceful death, and his family had a wonderful last few days with him.

Prolonging the inevitable with tube feeding and/or artificial ventilation would have given us more time with him physically, but he did not want that option. We were happy eventually that he had made that choice himself.

What's the first step in developing an advance care plan?

The first step in the advance care planning process is to think about what type of care you want or don't want and share these thoughts with your family and loved ones. At the same time, you should decide who you want to be your proxy.

What is a proxy and how do I pick one?

A proxy is the person you name to speak for you should you be unable to do so yourself. You can name anyone that you trust as a proxy, but they must be in sound mind, understand your wishes and be prepared to act accordingly.

What role does my family doctor play in this? Is it important for doctors to play a role in advance care planning?

Your family physician can play a very important role in helping you through the advance care planning process and creating a Health Care Directive. In my practice, I raise the issue on this sensitive topic during routine visits from my patients. My job is made easier by the fact that the Winnipeg Health Region offers a booklet that explains in simple detail all that my patients need to know on how to develop a Health Care Directive. It is important for all of us to develop a relationship with our primary care physician/family doctor over time so that they understand your values and aspirations to guide you through developing a suitable care plan.

Do I need a lawyer? Is a Health Care Directive a legal document?

A lawyer is necessary only to appoint an enduring power of attorney and to create a complex will. Although it may be worthwhile getting counsel, especially if there is disconnect in the family, and questions about mental competency, usually you do not need legal counsel for a Health Care Directive.

Will care be withdrawn if I request a Do Not Resuscitate Order?

No. A Do Not Resuscitate order means that if your heart stops, health-care providers will not try to restart it by giving you electrical shocks or doing chest compressions (CPR - cardiopulmonary resuscitation). Other forms of care will continue to be offered. Therefore, if you do not want other forms of medical care, such as tube feeding or artificial ventilation, you would need to specifically state this to your health-care provider or write it in your Health Care Directive.

How can I make sure that people working in the Emergency Department of a hospital know that I have a Health Care Directive?

Your Health Care Directive should be made available to your loved ones, health-care providers, family doctor.

How many Manitobans currently have a Health Care Directive? Are more people taking an interest in filling out a Health Care Directive?

Although Health Care Directives are becoming popular, many Manitobans still don't have one. But it is important to remember that as we age, we must come to terms with frailty, disease and mortality. Whether we get the best and most appropriate care depends on what steps we take. We will only get the care we want if we let our care providers know what we want.

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