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Planning for end of life
- 1. Your values, your wishes, your dignity Donna Clare RN MN Nurse Practitioner, Faculty, Athabasca University February 2014
- 2. We will discuss: •Why planning is important •What you need to consider •How to plan for end of life care decisions •Who to include in the discussion and how
- 3. Why bother? •Often there are choices to be made •Family members often disagree •Treatments have consequences •Prolonging life vs prolonging dying •Control over your own life
- 4. Two basic choices: •What you want •What you don’t want Based on: •Belief systems (life, death, purpose) •Personal values (preferences, dignity) •Character traits (coping, feelings) •Personal limits (pain, suffering, change)
- 5. •What is legal and illegal? •How much (pain, loss, indignity, treatment) is okay/not okay? •How do I prefer to die? •In what circumstances are tubes, machines and resuscitation okay and not okay? •Who will speak for me when I cannot?
- 6. •Active Euthanasia is not legal in Canada •Assisted suicide is not legal in Canada •Allowing normal processes to proceed without intervention is legal •Withdrawing earlier interventions is tricky but not illegal
- 7. •How do I want to live? •What is worth going through to continue to live? Will it prolong my life in a meaningful way? •How much ________is okay/not okay?
- 8. •How do I want to die? •When does prolonging life become prolonging dying? (Does this concept have any real meaning to me?) •Where do I want to die?
- 9. •In what circumstances are tubes, machines and resuscitation okay and not okay? What about organ donation?
- 10. Who will speak for me when I cannot? Health Care Proxy Substitute Decision-maker Medical Power of Attorney Health Care agent Durable power of attorney for health How can I direct them regarding my wishes? Who should know my wishes?
- 11. Power of Attorney – financial/legal Will – written instructions about your estate and sometimes burial details. Health Care Proxy – health care decisions Living Will/ Advanced Directive – written instructions for catastrophic or end of life decision-making
- 12. Should have knowledge about your wishes and the type of person you are Should direct care the way YOU would if you could - sometimes that means someone who can make these decisions and fight for you Should listen carefully, ask questions and consider your wishes when making decisions. Should act in YOUR best interest.
- 13. It provides guidance to family, health care personnel and your proxy when a decision must be made. It may decrease family tensions. Address non-medical ideas, too: what are your fears (alone, pain, losing control, abandoned,….) A living will should ideally be made when the person is healthy and of sound mind. And it should, ideally, be signed, dated and witnessed by 2 people
- 14. •Your health care proxy •Family members •Your lawyer •Your physician or Nurse Practitioner •A health care facility •You should name your health care proxy and an alternative in writing; in this or a separate document, signed dated and witnessed.
- 15. If I, as proxy, stop or refuse treatment I will be “giving up” on them. What will others think of me if I decide to stop aggressive treatment? If I have a will or living will, I will bring death on. If I have a living will, they will let me go sooner. Does stopping treatment mean stopping care? Dying from lack of food and fluids is painful What if I make the wrong decision?
- 16. •Express your feeling of helplessness should something happen •Express your need to honour their wishes but you need to know what they are •Bring up an experience and explore their perspectives •Small bites versus the big talk