Advance Care Planning for Every Stage of Life: From Unexpected Accidents to End of Life
A Living Will is a legal document that tells others how you feel about care intended to sustain life. You can choose to accept or refuse medical care. There are many issues to address, including:
- If you want to be resuscitated if your breathing or heartbeat stops
- If you would be open to the use of dialysis and/or breathing machines
- If you would like to receive tube feedings if you’re unable to eat or swallow
- If you wish to donate organs or tissue
A Living Will must be signed, dated, and witnessed by two people. For the Living Will to be valid, the health care provider must declare the person to be in a terminal condition or in a condition that (without life sustaining treatment) will result in death within a relatively short time.
Durable Power of Attorney (DPOA) for Health Care
A DPOA is a written document that names your health care proxy. Your proxy is someone you trust to make health decisions if you are unable to do so. The health care proxy can make decisions regarding your medical treatment, including:
- Refusal of treatment
- Agreement to treatment
- Withdrawal of treatment
A DPOA for Health Care becomes active any time you are unconscious or unable to make medical decisions. It must be signed and dated.
The Five Wishes is a helpful and user-friendly Advance Directive healthcare document that combines a Living Will, DPOA for Health Care, and addresses matters of comfort and spirituality. The document is based upon the following Five Wishes:
Wish 1: The Person I Want to Make Care Decisions for Me When I Can’t – This section is your
DPOA for Health Care and assigns your health care proxy.
Wish 2: The Kind of Medical Treatment I Want or Don’t Want - This section is your Living Will.
Wish 3: How Comfortable I Want to Be – This section addresses matters of comfort care including pain, symptom management, personal hygiene, and whether you would like to know about options of hospice, among other things.
Wish 4: How I Want People to Treat Me - This section speaks to personal matters, such as whether you would like to be at home or have friends visit you during your illness.
Wish 5: My Wish for What I Want My Loved Ones to Know – This section deals with matters of forgiveness, how you wish to be remembered, and final wishes regarding funeral or memorial plans.
Wish 1 and Wish 2 are both legal documents. The Five Wishes health care document needs to be signed and witnessed by two people to be valid in Montana. Completion of the Five Wishes document meets requirements for Living Will and Durable Power of Attorney for healthcare. It is not necessary to complete a separate Living Will or Durable Power of Attorney form.
For more information on Five Wishes, you may visit: www.fivewishes.org
A healthcare provider may presume that a declaration executed in another state, but which complies with Montana state law is a valid advance directive.
The POLST document is a Physician's Order. The POLST is intended for anyone with an advanced life-limiting illness and is recommended in addition to a Living Will and Durable Power of Attorney. It is a medical form indicating what types of life-sustaining treatments you do or do not want if you become seriously ill. The POLST must be signed by a healthcare provider (physician, nurse practitioner, or certified physician assistant). The POLST can be utilized during emergent transport situations, transport between care settings, in the hospital, at home, or in long-term care.
The POLST form has replaced Comfort One although the Comfort One form is still honored by emergency personnel.
For more information, visit http://www.polst.mt.gov.
When do your Advance Care Directive health care documents take effect?
Your Advance Directive health care documents take effect if your doctor determines that you lack the ability to make your own health care decisions. Lacking ability usually means that:
- You can't understand the nature & consequences of the health care choices that are available to you.
- You are unable to communicate your own wishes for care, either through speaking, writing, or gestures.
What should you do with your completed Advance Directive forms?
After completion of your Advance Directive document, you should provide a copy to each person named as your DPOA and send a copy to the Medical Records Department of any hospital where you might be
admitted. You may also want to place a copy of your Advance Directive on the Montana End of Life Registry.
The registry stores Advance Directives in a secure computer database and makes these documents available nationwide to health care providers and registrants. The web site address is www.doj.mt.gov and access Advance Health Care Directives.
Can you choose to change your Advance Directives?
You may change or cancel your Advance Directive health care documents at any time if you are considered of sound mind to do so. Being of sound mind means that you are still able to think rationally and communicate your wishes in a clear manner. A new form should be completed, and all previous documents destroyed. Make sure that your doctor and any family members who knew about a previous Advance Directive are also aware that you have changed them.
Forms are available at your physician’s office.