What You Should Know About Advance Care Planning
If you become injured or too sick to tell your doctors what kind of healthcare you want, how would they know how you’d want to be treated? Because no one can predict when a medical emergency may occur, it’s important to talk with your loved ones about your healthcare preferences before there is an emergency.
Advance Care Planning
This is where Advance Care Planning comes in. Advance Care Planning gives adults at any age or stage of health an opportunity to think ahead and prepare for unexpected situations life may bring.
Stephanie Van Slyke, senior coordinator of Advance Care Planning and Ethics for Munson Medical Center explains:
“Advance Care Planning allows your voice to be heard, even if you cannot speak. Your loved ones and your healthcare team cannot honor your wishes if they don't know what they are. Advance Care Planning involves learning about the types of medical decisions that might need to be made now, in the future, and at end of life and encourages ongoing conversations with your family and your medical team to better understand your goals for living a meaningful life.”
Advance Care Planning Involves Two Key Components:
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Choosing a person who you trust to speak for you should you ever become suddenly injured or too sick to tell your healthcare providers your wishes.
This person is called your patient advocate. Your patient advocate should be someone who is:
- Strong enough to honor your wishes even if that means you don’t want to receive certain medical treatments that would prolong your life.
- Strong enough to honor your wishes even if other family members disagree or do not like the wishes you have made.
- Strong enough to manage stressful and emotional situations.
- Putting your wishes in writing.
Advance Care Planning documents that outline your treatment preferences are referred to as an advance directive (also referred to as a durable power of attorney for healthcare or a patient advocate designation).
Additional documents can include an out of hospital medical order, such as a Do-Not-Resuscitate (DNR) order or a Michigan Physician Orders for Scope of Treatment (MI-POST).
Advance Directive
An advance directive allows you to list your treatment preferences and appoint a person (and alternates) to be your patient advocate. Your patient advocate will be your voice if you become unable to tell the people caring for you what you want.
Your patient advocate only speaks for you when you have been determined unable to make your own decisions by two physicians, or a physician and a licensed psychologist.
In the event you are hospitalized and do not have an advance directive, the doctors will lean on your family members. As a last resort, or if there is disagreement among family members, a guardian may need to be appointed by the court.
In addition to an advance directive, if you have a serious illness or advance frailty, you may also want what is known as an out-of-hospital medical order such as a DNR order or a MI-POST. These documents inform Emergency Medical Service (EMS) personnel of your treatment preferences should 911 be called on your behalf.
EMS personnel are required to perform CPR on all patients when 911 is called unless you have a Do-Not-Resuscitate (DNR) order or a Michigan Physician Orders for Scope of Treatment indicating a DNR.
Michigan Do-Not-Resuscitate Order
The Michigan Do-Not-Resuscitate (DNR) order is an out-of-hospital medical order intended for adults and minors living with advance illness who do not want to have CPR performed should they experience a medical emergency. Unlike an advance directive, this document can be acted upon by EMS personnel instructing them not to perform CPR.
Michigan Physician Order for Scope of Treatment Order
The Michigan Physician Order for Scope of Treatment (MI-POST) is another type of out-of-hospital medical order intended for adult patients who have advanced frailty or serious illness resulting in a shortened life expectancy of a year or less. It too is actionable by EMS personnel instructing them whether or not to perform CPR in addition to other aspects of medical care, such as selective or comfort-focused care.
If a person is brought to the hospital, these documents are only advisory, meaning they are not standing medical orders in a hospital setting. Hospital personnel will ask you what your wishes are each time you arrive at the hospital.
This table further explains the differences between the advance directive, DNR and the MI-POST.
Advance Directive/DPOAH | Michigan DNR | MI-POST | |
| Who is the document for? | Anyone 18 years or older who is able to exercise sound judgement, regardless of health status.
| Adults or minors with an advance illness or significant functional impairment that is not reversible. | Adult patients who have advanced frailty or serious illness resulting in a shortened life expectancy of a year or less. |
| What does the document do? | Identifies who the patient has designated as their patient advocate(s). May, or may not, outline wishes about medical treatments, CPR or life-sustaining treatment preferences. | Indicates the patient does not want CPR. | Identifies what care the patient should receive if they require medical attention.
May indicate “Attempt CPR.”
|
| Is there a standard form? | NO, many varieties. May be called a DPOAH, an AD or a Patient Advocate Designation (when valid they are all treated synonymously). | NO, the state only provides guidelines for what needs to be on the form. Printed on standard white paper. Photo copies of the original are acceptable. | YES, standardized by state. Printed on pink paper (preferred). Photo copies of the original are acceptable. |
| Who completes the form and signs the form? | The patient. | The patient’s attending physician.
Cannot be a nurse practitioner or physician’s assistant. | The patient’s attending physician, nurse practitioner, or physician assistant. |
| What are the signature requirements? | The patient.
Two witnesses.
The patient advocate(s), upon acceptance.
| The patient’s attending physician. The patient (or the patient’s patient advocate/guardian when applicable). Two witnesses. | The patient’s attending physician, NP, or PA. The patient (or the patient’s patient advocate/guardian when applicable). |
| Are there witness requirements? | YES Witnesses must be at least 18 years of age and cannot be any listed patient advocates, family members, healthcare or mental health facility employees where the patient receives care, or employee of a life or health insurance provider. | YES Two witnesses. Witnesses must be 18 years of age or older, at least one of whom is not a spouse, family member or direct heir to the patient.
| NO |
| When does it go into effect? | Only when activated. Activation requires a capacity determination by two physicians or one physician and a licensed psychologist. | Effective immediately. | Effective Immediately. |
| Is this document followed by Emergency Service personnel? | NO | YES | YES |
| Is it easy to understand? | Can sometimes be vague. | Easy. Only directs that CPR be withheld. | Easy. |
Advance Care Planning is an important step to make sure you get the medical treatment you want. Even if you’re not sick now, planning for your healthcare in the future can help save those nearest and dearest to you unneeded stress later.
We’re Here to Help
Every month, Munson Healthcare offers free, virtual workshops outlining the Advance Care Planning process that includes:
- A workbook with step by step instructions for getting you advance care planning started.
- Information about healthcare decisions you may need to consider now, or in the future.
- Guidance for choosing someone you trust to speak for you if you become suddenly injured or too sick to speak for yourself.
- A page by page walk through of an advance directive so you know how to put your wishes in writing.