Source: Teno, JM et al. Family perspectives on end of life care at the last place of care. JAMA. 2004;291:88-93
- 88% say they want to die at home
- Have conversations with your loved ones
- Write down your values and wishes
- Power of Attorney for Health Care
- (Durable Power of Attorney”)
- Other written documentation of your wishes/values
- Conversations with your loved ones
- Living Wills (state specific)
- POA for Health Care (usually part of LW)
- Other documentation of your values and wishes (see ABA toolkit, Caring Conversations, Five Wishes)
- Artificial Nutrition & Hydration
- ***May instruct YES or NO
- Allows you to name someone to make decisions for you, if you are unable to make them yourself
- Doesn’t take effect UNTIL you are unable (“springing”)
- Usually has space for 2 decision-makers, in case one is unavailable
- Can act for you ONLY if you are UNABLE TO MAKE DECISIONS for yourself.
- MUST make decisions IN AGREEMENT WITH YOUR DESIRES as stated in your Living Will or as otherwise known to the agent.
- If your wishes are unknown, they must make decisions “in the patient’s best interest”
- You do NOT need an attorney
- You do NOT need a notary in DE/PA/NJ/MD
- You DO need two witnesses, not related to you, who will not inherit from you, who don’t work for the facility where you live.
- Make copies and distribute
- Keep several copies yourself and take to hospital or facility if you go
- Copies have the same force as an original
- Each state has a hierarchy of decision makers. In Delaware—
- Guardian: Adult who has exhibited special care and concern—IF none of above are available AND if appointed by the court.
- If you do more than 1, make sure they all agree
- Only when a patient is terminally ill or in a persistent vegetative state
- Whenever a patient is incapable of making or communicating a choice.
- On a scale of 1 to 5, where do you fall on this continuum?
- If there were a choice, would you prefer to die at home, or in a hospital?
- Could a loved one correctly describe how you’d like to be treated in the case of a terminal illness?
- Is there someone you trust whom you’ve appointed to advocate on your behalf when the time is near?
engage with grace .org The One Slide Project 1 2 3 4 5 Don't give up on me no matter what, try any proven and unproven intervention possible Let me die in my own bed, without any medical intervention
- Have you completed any of the following: written a living will, appointed a healthcare power of attorney, or completed an advanced directive?
- Not all family members are “ready to let go”
- Physician feels “we have to do something”, and family goes along
- Cannot find LW/have not talked about it
- Living will is unclear in present situation.
- Think about your values and wishes for the end of life
- Have a conversation with your loved ones
- It’s may be difficult now, but it will save bigger difficulties later
- EMS Providers will honor a new form called
- Medical Orders for Life Sustaining Treatment (or MOLST)
- All adults are encouraged to complete a living will and power of attorney.
- MOLST—only for people with a terminal illness who do not want to be resuscitated in an emergency.
- MOLST—intended to be used in the last year of life.