Introduction
People may find it difficult to address questions related to their health towards the end of their life or during emergencies. Advance care planning plays an important role in this scenario. Communicating one’s desires of future treatment aspects, death, and burial to their medical managers or close relatives can help to prevent confusion later in life. Making decisions based on assumptions can be avoided, and one can die peacefully, having even the smallest of their desires fulfilled, by planning the future. It needs to be stressed that the future is always uncertain, and planning does not ensure a ‘fairy-tale ending.’ However, it can minimize confusion and panic in an emergency situation.
What Is Advance Care Planning?
Advance care planning involves discussing and preparing one’s future decisions regarding their medical care for a time when they become critically ill or unable to make their wishes known. A meaningful and open conversation with their loved ones or medical managers can help with this. Reflection, deliberation, and determination of one’s preference for treatment options in the future are done in advance care planning. This should be made known to their relatives, future substitute decision-makers, and healthcare professionals.
What Is Advance Directives?
Some people prefer to put their future plans and preferences in written scripts as legal documents. This is called advance directives. The two most common advance directives include the living will and the durable power of attorney for healthcare.
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Living Will: A legal document that communicates a person’s preferences for their medical treatments to a healthcare provider is termed ‘living will.’ In short, it informs the doctor of how one would like to be treated when one is not in a position to communicate effectively. It can give information about the common medical treatments that the patient would want, the ones they would like to avoid, and the conditions under which these options become valid. This is different from a ‘will,’ which provides information about their property and financial assets.
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Durable Power of Attorney for Healthcare: This is a legal document that names a person responsible for making decisions regarding healthcare options when one cannot communicate them efficiently. This person is called a healthcare proxy, representative, surrogate, or agent. This person is generally familiar with the patient’s likes and dislikes and values the patient’s opinions. This can help one to manage unexpected incidents like a serious car accident or stroke.
These documents would need to be revised occasionally to update a person’s health status. This can include after diagnosing a health condition, moving out to a new place, or retiring in life. This enables them to carefully plan the treatment options available and the ones they would like to opt for or avoid.
What Are the Contents of Advance Directives?
There are no strict guidelines on what to include in an advance directive, or on the minimum content it should have. An advance directive is known by many names across the countries. For instance, it is known as the Living Will (LW) and the Durable Power of Attorney for Health Care (DPAHC) in the United States. On the other hand, in the United Kingdom, it is known as Advance Decision to Refuse Treatment (ADRT).
An advance directive may be an elaborate and detailed report with consequent advantages and disadvantages. According to the Council of Europe document, a very brief advance directive may not give ample information on the desires of the patient, while a very elaborate one might be confusing to the health proxy. Another limitation is that a person’s perspective may change with time, and how one sees life and medical options while young might not be similar when they become old. Some things that they considered beneficial while young might turn out to be fearful as they get older and more fragile. Hence, timely updating of the advance directive is essential. Almost all advance directives should contain information regarding the interventions (for example, antibiotics, cardiopulmonary resuscitation, hydration, use of ventilators, analgesia, feeding), life-sustaining treatments, resuscitation, and the healthcare proxy (or the one who would be making decisions for them).
When an advance directive is vague or confusing, the healthcare professional might ask the opinion of the healthcare proxy. This enables them to understand the likes and dislikes of the patient and provide treatment accordingly.
Who Requires Advance Care Planning?
People of any age can plan for advance care planning. There is no perfect timing for it. This is not necessarily an event for the elderly. A person can have a health issue at any point in life, which may leave them unable to communicate their wishes effectively. Planning at a young age helps one to be certain of the future to some extent and to have someone informed about one's likes and dislikes.
When a person has a chronic health issue that is mild to moderate, they can start advance care planning. A recent hospital admission or a health crisis can be a point where one can start planning their healthcare options. In early conditions, when one is still healthy and able to make wise decisions, it is advisable to start planning for a stage where one would be unable to do so.
Guessing the future conditions or diseases one may possess in the future can be challenging at a young age. However, these can be planned using their current diet and lifestyle. This can be modified from time to time, depending on the changes in health status. For some conditions like early stages of dementia (memory loss), it is advisable to plan for their health in advance. This can enable them to get good medical care according to their desires.
What Are the Barriers to Advance Directives?
The barriers to advance care planning can include:
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Lack of Awareness: Most people are unaware of the options available for advance care planning.
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Denial: In some cases, they might be denied the option to plan their healthcare options. This can be due to many reasons, such as financial constraints, the unavailability of proper facilities in their locality, etc.
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Confusion: People might still consider themselves young and might be confused about the benefits of starting an advanced care plan.
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Beliefs and Cultures: Some religions might not approve of planning for one’s later days. It might also be against cultural norms.
Conclusion
Planning for a period when one becomes fragile to make one's own decisions in life is called advanced care planning. It enables one to get the best medical care available according to their heart’s desire. It is beneficial in case of an unforeseen incident that leaves the patient inefficient in communicating their opinions efficiently. This helps them to be prepared for an uncertain future to an extent.
