An advance directive, also known as an advance care plan, is a generic term used to describe a document that outlines your medical care preferences. Our Care Wishes calls this a “wishes document”. The preferences you choose would be used to guide decisions about the care you receive if you became unable to communicate on your own behalf.
A blank wishes document is included in the Our Care Wishes packet. The purpose of this form is to let your doctors and loved ones know: who would make decisions for you if you became unable to speak for yourself, and what medical care you would and would not want.
Your doctors and the rest of your care team at Penn Medicine want to provide you with the care you want whenever possible, and by providing an advance care plan, you will let us know what that is. Creating a document is the best way to ensure that you receive all types of care you do want, and none of the care you don’t want.
Penn Medicine’s downloadable Our Care Wishes packet allows you to print, create, store and share a document containing detailed preferences about your wishes for care. A fillable document outlining your health care decision makers, quality of life and treatment preferences begins on page 10 of the Our Care Wishes packet.
Your document is meant to serve the purpose of an advance directive. If you want to make your document a “legal” advance directive, you will have to follow certain extra steps. The requirements vary from state to state and are subject to change. The most common requirement is that the document be signed by you and two witnesses or a notary.
If you are concerned with the legal status of any document you create, you should consult with legal counsel and/or refer to your state’s specific legal requirements. You can also find copies of blank forms to make advance directives from many sources. You do not need to use a specific template.
If you do not have an advance care plan documented and available for care providers and loved ones, you may not receive care that you would want, or you might receive care that you do not want. Additionally, your loved ones could be faced with making difficult decisions and may be uncertain about what decisions to make regarding your care.
When an individual does not have their wishes recorded, and becomes unable to speak for themselves, a relative that person would not have wanted to make decisions for them may be the legal default in charge of their medical care. The patient may receive treatments that are not in alignment with what they wanted. Without a care plan, there would be nothing to protect against these situations.
Each state has its own policies on exactly when an advance care plan can be used. Similarly, different care providers can choose to use these documents in a variety of ways depending on the circumstances.
Generally, advance care plans are used at a point when a patient has a terminal illness (they will not get better) and is no longer able to communicate (not able to talk, write, or express their opinions in any way), is not considered competent (unable to make decisions), or is permanently unconscious (they won’t wake up).
Yes. There are many types of advance care plan documents. Each state may recommend a particular form, but it is your choice which form you use to document your care preferences.
The Our Care Wishes packet is the document preferred by Penn Medicine.
If a person becomes very sick and they are either permanently unconscious (won’t wake up) or have an end-stage medical condition (won’t get better), a wishes document can help to relieve their loved ones’ fear and uncertainty. The document is most commonly used as a conversation guide between care providers and the patient’s loved ones to determine which medical treatments best align with the patient’s values and preferences.
It can be difficult for family members if they are ever burdened with making decisions about what health care you should receive. The document you create provides guidance by telling them your wishes and what matters to you. A wishes document can also be useful in helping to resolve any conflict between loved ones who may have differing points of view on what health care you would want.
Discussing your values and care preferences with loved ones and care team can help them make the decisions that you would want if you were no longer able to communicate. Having your wishes documented and sharing it with others helps to make your wishes available if and when. It helps your care providers discuss treatment options with your loved ones and makes it much easier for everyone to confidently make decisions that they believe you would want.
Everyone. It is never too early to discuss and document your care preferences.
There are 2 basic components of an advance directive document:
- Living Will: your personal values and what would be most important to you
at the end of life
- Durable Power of Attorney: selecting your health care decision maker(s)
Our Care Wishes first asks you about quality of life preferences and if there are ways of living that you would find unacceptable. After that, you will specify which life sustaining treatments you do or do not want if you become very ill and will not get better. You will be asked about organ donation preferences. Another important component of the document is choosing your health care decision makers. These should be people you trust to make choices for you.
It is important to remember that all the choices you make on your wishes document are in the context of being very sick and unable to communicate. That is the only time this document would come into effect.
The most important thing to consider is what you value in life for yourself and those around you. Though it is difficult, it is important to consider if there are things you must be able to do to feel your life is worth living, or if there are states of living that would be unacceptable to you.
Some people find it helpful to talk to their loved ones, health care providers, community leaders, or religious leaders whose perspectives they value. These individuals can help you talk through your thoughts and beliefs about end of life care. Take your time and remember the discussion is the most important part.
Life sustaining treatments replace or support bodily functions that are no longer working. When people have treatable conditions, life sustaining treatments are used temporarily until the illness or disease can be stabilized and the body can resume normal functioning. At times, the body never regains the ability to function without life support or life-sustaining treatment.
Some common examples of life-sustaining treatments include:
- Intervention if your heart stops, including cardiopulmonary resuscitation (CPR).
- Intubation, the placement of a flexible plastic tube into the trachea (windpipe) to maintain an open airway, so you can breathe.
- Mechanical ventilator, machine assisted breathing.
- Dialysis, the clinical purification of blood by a machine that substitutes for the normal function of the kidneys.
- Antibiotics to treat infections.
- Artificial nutrition and hydration, liquid food or water that is medically supplied by a tube into your nose, or directly into your stomach, intestine, or veins.