Personal Directive

I have written about the importance of a Personal Directive (PD) forming part of your estate plan in previous columns.  A PD allows you to:

• Choose a person to act as your Health Care Agent (Agent);
• Give instructions to your Agent about your health care which can include your end of life wishes.

Your PD gives your Agent the authority to make your decisions only when you no longer have the mental capacity to make decisions yourself.

Problem

Most people understand they need a PD and at the same time, are confused about what medical treatment is available when thinking about their end of life decisions (advance care planning). It is important to know the difference between a DNR (do not resuscitate), DNI (do not intubate) and No CPR (no cardio pulmonary resuscitation.

If you are admitted to hospital, you will be asked to provide your instructions about what level of care you want. Admissions to hospital are stressful, especially in chronic illness and end of life situations. It is hard to think carefully and clearly when under this kind of stress. Waiting until this stressful situation occurs is not the best time for you or your family to be thinking about, discussing and making decisions.

It is better to consider your future health care decisions in a less stressful environment. If you are not clear about your wishes, how will your Agent and family, make sure they are following your wishes and instructions? For many reasons, parents and children find it challenging to talk about death and end of life decisions.

Solution

Alberta has set up a province wide program to promote advance care planning. The Goals of Care Designation is an Alberta Health Services form you will complete with your doctor or primary care nurse. In your Goals of Care Designation you will provide instructions to guide medical staff about your future care. The doctor or nurse will write your Goals of Care Designation as a medical order, after speaking with you and/or your Agent. The purpose of the Goals of Care Designation is to allow medical staff to provide care that best reflects your wishes and values, depending on your health condition.  Health care involves three general approaches: Medical, Resuscitative, and Comfort. Within each approach there are sub-categories. Talking to your health care team about these approaches will help you complete a Goals of Care Designation that reflects your existing health condition, wishes and values. You can change your Goals of Care Designation in the future, if you choose or if your circumstances change.

Communication

It is important your Agent and family are aware of your Goals of Care Designation so medical staff can be made aware of your wishes in your Goals of Care Designation as soon as possible if you are admitted to hospital.   Your completed Goals of Care Designation form and your PD then need to go into a Green Sleeve folder that comes with the your Goals of Care Designation form. The Green Sleeve is recognized by medical teams in Medicine Hat and throughout Alberta.  When you go to hospital or access any medical care take your Green Sleeve folder with you and show it to medical staff so they know about your decisions.

AHS recommends you keep your Green Sleeve folder on or near your fridge. Emergency Medical Responders are trained to look for it on your fridge if they are called to your home.  You should take your Green Sleeve folder with you when you meet with your health care providers, whether in the hospital or at your doctor’s office.

Conclusion

The British Medical Journal reported on an Australian study which followed a number of patients aged 80 or over for a period of 6 months or until death. Some received standard care while others received the same care plus help with advance care planning in which they were encouraged to document their values and wishes and appoint an Agent. Of the patients who died within the 6 month period, end of life wishes were more likely to be respected in the group that documented their advance care plan. Also, and maybe even more importantly, the families of those patients suffered less stress and anxiety over the decisions that were made.

Health care providers in Medicine Hat have the Goals of Care Designation forms. You can also find them at www.albertahealthservices.ca/ps-1023351-acp-policy-append-a.pdf.  Completing this form is an important task for any person who is 18 or older, as end of life decisions may unfortunately happen at any age. The Goals of Care Designation will make it easier for your Agent, family and health care providers to know they are following your wishes and instructions.

For more information on the Goals of Care Designation go to: www.albertahealthservices.ca