Advance Care Planning

Advance Care Planning
Share your wishes. Start the conversation today.
 
Advance care planning is an important part of making sure you receive the medical care that you want, in the event that you are unable to share your wishes. Its impact on your family could eliminate the stress and uncertainty that comes with making a difficult decision on your behalf.
 
Advance care planning is not about your age or overall health. It’s about being ready for whatever comes your way. Every adult should have an advance care plan, no matter his or her age. After talking with your loved ones about what you would want, it’s time to express your wishes in writing.
The three basic steps of advance care planning:
  • Think about your wishes and talk with your family
  • Decide what care plan is right for you
  • Write down your choices to create your advance care plan

Pennsylvania’s advance directive law (Act 169 of 2006) has been revised to provide greater clarity to individuals and healthcare providers regarding the use of advance directives. Below are a series of questions and answers about Pennsylvania’s advance directive law.

  • You should start Advance Care Planning today to retain control over your medical care in case there is a time when you are unable to make your own decisions
  • Advance Care Planning tools include:
    • Advance directives (living will and healthcare power of attorney)
    • POLST (Pennsylvania Orders for Life Sustaining Treatment)
  • A living will is a document that expresses your wishes regarding end-of-life care
  • Healthcare power of attorney is a document that enables you to appoint someone to make decisions for you
  • POLST is a document, signed by your physician, that translates your end-of-life wishes into a physician order
  • It’s very important to think about the care you want or don’t want, to discuss these wishes with your physician, family, and friends, and to appoint a decision maker you trust
  • If you don’t have an advance directive and are unable to make you own decisions, it’s possible that people you don’t want making decisions for you will be the ones making decisions
  • It’s never too early to start Advance Care Planning
  • Everyone should have an advance directive, regardless of age

What are Advance Directives?

A living will allows you to document your wishes concerning medical treatments at the end of life. 

Before your living will can guide medical decision-making two physicians must certify:

  • You are unable to make medical decisions,
  • You are in the medical condition specified in the state's living will law (such as "terminal illness" or "permanent unconsciousness"),
  • Other requirements also may apply, depending upon the state.

A medical power of attorney (or healthcare proxy) allows you to appoint a person you trust as your healthcare agent (or surrogate decision maker), who is authorized to make medical decisions on your behalf. 

Before a medical power of attorney goes into effect a person’s physician must conclude that they are unable to make their own medical decisions. In addition:

  • If a person regains the ability to make decisions, the agent cannot continue to act on the person's behalf.
  • Many states have additional requirements that apply only to decisions about life-sustaining medical treatments.
  • For example, before your agent can refuse a life-sustaining treatment on your behalf, a second physician may have to confirm your doctor's assessment that you are incapable of making treatment decisions.

What Else Do I Need to Know? 

  • Advance directives are legally valid throughout the United States. While you do not need a lawyer to fill out an advance directive, your advance directive becomes legally valid as soon as you sign them in front of the required witnesses. The laws governing advance directives vary from state to state, so it is important to complete and sign advance directives that comply with your state's law.   Also, advance directives can have different titles in different states.
  • Emergency medical technicians cannot honor living wills or medical powers of attorney. Once emergency personnel have been called, they must do what is necessary to stabilize a person for transfer to a hospital, both from accident sites and from a home or other facility. After a physician fully evaluates the person's condition and determines the underlying conditions, advance directives can be implemented.
  • One state’s advance directive does not always work in another state. Some states do honor advance directives from another state; others will honor out-of-state advance directives as long as they are similar to the state's own law; and some states do not have an answer to this question. The best solution is if you spend a significant amount of time in more than one state, you should complete the advance directives for all the states you spend a significant amount of time in.
  • Advance directives do not expire. An advance directive remains in effect until you change it. If you complete a new advance directive, it invalidates the previous one. 
  • You should review your advance directives periodically to ensure that they still reflect your wishes. If you want to change anything in an advance directive once you have completed it, you should complete a whole new document.