Vital Aging Network

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Choosing Care for the End of Your Life

By Michele Fedderly, Executive Director, Minnesota Network of Hospice and Palliative Care

In earlier times, people didn’t have many choices when it came to end-of-life care. Today, the miracles of modern medicine make healthcare decisions much more diffcult. It’s important for each of us to take the time, while we are able, to reflect on the type of care that we want if we become seriously ill. And it’s important to talk with the people we love so they can know what we want.

People are often reluctant at first to talk about these issues. No one likes to anticipate serious illness. We hope that we will remain healthy until we die peacefully in our sleep. The statistics tell us, however, that we are far more likely to live our last years—not days or weeks—with a chronic, debilitating illness, having to face numerous diffcult healthcare decisions. And for some of us, our loved ones will have to make those diffcult decisions because we won’t be capable of making them for ourselves.

How can you prepare for such decisions before you know what they are? One important decision you can make in advance is to choose a healthcare agent—the person who will make healthcare decisions for you when you can’t make them yourself. You can choose someone who knows you well, whom you trust, and who will be an effective decision maker and advocate, even if decisions have to be made in a crisis. You can discuss your feelings and beliefs about life-prolonging treatments with your agent and create a plan for how he or she should make these decisions.

A next step is to write down the plan in the form of a healthcare directive, also known as a living will. In Minnesota, a healthcare directive is the legal way to name a healthcare agent. Although healthcare directive forms are available from hospitals, clinics, attorneys, and online, a recent national study found that over 40% of people have not completed a healthcare directive. To assist people in Minnesota and increase the number of completed healthcare directives, a metrowide project—Honoring Choices Minnesota—was begun. For this effort, the project developed a simplified healthcare directive form, as well as educational materials, and trained facilitators to help people complete the form. Several clinics and hospitals are now pilot sites for the Honoring Choices Minnesota program.

Another important effort underway in Minnesota is POLST (Physicians Order for Life-Sustaining Treatment), a form that translates a person’s wishes into an order that a physician signs and that EMS and other healthcare providers will honor. You can use your healthcare directive as a starting point for completing the POLST form with your physician. The project recommends a POLST form for people with advanced, chronic, progressive illnesses or anyone wishing to further define his or her preferences of care.

For more information, attend the VAN forum Understanding End-of-Life Options: Getting to the Heart of the Matter on Tuesday, October 12 from 10:30AM to 12:30PM. To register, go to www.vital-aging-network.org. You also can obtain resources and information from the Minnesota Network of Hospice & Palliative Care at www.mnhpc.org, 1-800- 214-9597 or 651-659-0423.

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