By Maija Sanna, M.D.
There is something magical about the beginning of a new year. For some, it may be the excitement and anticipation of things to come in 2014: the birth of a grandchild or great-grandchild, marriage, travel, or planned family gatherings.
Alternatively, it might be the sense of closure after difficult times last year, such as loss of a loved one or coping with new illness. Maybe it is both, maybe it’s neither. Regardless, saying goodbye to 2013 and hello to 2014 marks a time to reflect and plan.
You may have already made New Year’s resolutions for 2014, including:
• Eat more vegetables and less fat.
• Get more exercise.
• Spend more time with family.
• Learn a new skill.
Resolutions or not, many people have aspirations for 2014. Planning for your health and wellness in the New Year is important, but I also like to remind my patients and others to give equal care and consideration to planning for their wishes in the event of illness. It might not be as much fun, but it is every bit as important.
Let me start by introducing a few of the terms and documents that are used to help discuss and record your wishes.
The Advance Care Directive is a legal document that has five parts. First, identify whom you would want to appoint for your Power of Attorney for Health Care – your “agent.”
This is the person you want to make your medical decisions if you are unable to make them for yourself. It’s a good idea to designate a second person in case your first choice is unavailable.
The second part is where you give individual instructions (aka living will). Here, you state your general wishes about end-of-life care.
In part three, you document your wishes with regard to organ donation.
Part four allows you to designate your primary physician.
Part five has signatures, witnesses, and notary.
Remember that advance directives only go into effect if a physician has determined that you are unable to make your own decisions. Once completed, this document does not expire, but it can be revoked and if you complete a new advance directive, it will invalidate any prior one.
POLST, or Physician Orders for Life-Sustaining Treatment, is a form that documents what medical treatments you would want in specific situations. It has four parts.
Part A asks what your wishes are if your heart stops. There are two options: 1) attempt resuscitation/CPR or 2) do not attempt resuscitation/DNR.
In part B you state your wishes about other medical interventions, ranging from comfort measures only to full treatment in the ICU with a breathing tube.
Part C discusses feeding tubes or artificial nutrition wishes.
Part D has signatures.
Both of these documents should be vital components of your health record.
While there are some similarities, they do have differences. The advance directive provides instructions for future treatments and legally appoints a healthcare representative or agent, but it does not guide emergency medical personnel, such as paramedics. It can, however, guide hospital treatment decisions if you are unable to make your own decisions.
The POLST form can guide emergency personnel when available and it provides medical orders for your current treatment. Importantly, the POLST should be completed and signed with your primary physician.
This is a brief introduction to two important documents that everyone should complete, regardless of current health. If you already have completed them, make sure to bring copies to your primary physician to be added to your medical record. If not, your doctor can walk you through the details and give you the documents to fill out.
Equally as important as completing these documents is discussing your wishes with your healthcare agents.
Although it can be anxiety provoking to make decisions about unforeseen health events, it should be comforting to know that your wishes will be understood and respected.
My recommendation is to focus on discussing what is most important to you right now. Remember, this is a moving target; your needs may change as your life and health changes. The New Year is an ideal time to review your wishes and discuss them with your physician and loved ones.
Here’s to a happy and healthy New Year! I have a feeling 2014 is going to be great.
Dr. Maija Sanna is a board-certified geriatrician with the highly regarded UCLA Geriatrics Program in Santa Monica and Westwood. For more information, call 310.319.4371 or visit www.uclahealth.org.