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Planning early for end-of-life care

Advance directivesWhile 80 percent of Americans believe in planning for their future, only 20 percent complete advance medical directives. These directives inform physicians and loved ones of a patient’s medical preferences and designate a surrogate decision-maker if a patient is unable to make decisions on his own behalf. Under Illinois law, this includes the creation of a living will and designation of power of attorney.

In a living will, a person explains their wishes that death either be delayed or not be delayed. It requires two witnesses, but not necessarily a lawyer or notarization.

The power of attorney is the “agent” who can specify the patient’s treatment wishes. This person supersedes any next-of-kin list, and the paperwork requires a lawyer’s signature.

Social worker Lindsey Hogan spoke about advance directives at the monthly Learning Café. “Advance directives are not required by law, and that’s unfortunate,” she said, addressing the crowd. “Without this paperwork, for example, an ER must do everything possible to resuscitate.”

Depending on circumstances, not every patient wants to be resuscitated. Under the Patient Self-Determination Act, patients have the right to accept or refuse care. However, the patient must be able to make his own decisions or have previously appointed a decision-maker.

In a living will, a person explains their wishes that death either be delayed or not be delayed. It requires two witnesses, but not necessarily a lawyer or notarization.

The power of attorney is the “agent” who can specify the patient’s treatment wishes. This person supersedes any next-of-kin list, and the paperwork requires a lawyer’s signature.

A person can also make a Do Not Resuscitate (DNR) request. This explains a person’s wishes in case of cardiac arrest. It requires two witnesses and a physician’s signature. It does not need a lawyer’s signature or notarization. However, it stays with the patient’s chart on official, state-approved colored paper.

A person may also fill out paperwork called “five wishes.” This addresses  medical, emotional and spiritual aspects of care and can be found online at agingwithdignity.org. It does not require a lawyer or notarization.

Hogan advised that patients not wait for their doctors’ suggestion to start on these documents. “Many patients expect the physician to initiate planning,” Hogan said. That is rarely the case, though.Without a plan in place, the physician must follow the Healthcare Surrogate Act, appointing a surrogate decision maker based on next of kin. This list begins with a court appointed guardian and extends to spouse, adult child(ren), parent, adult sibling, adult grandchild(ren), close friend and finally estate guardian. The physician decides when this is necessary by considering whether the patient can communicate, understand relevant information, appreciate the situation and consequences, and reason.

“As long as you’re able to make decisions, you’ll certainly have the power to do so,” Hogan said.

Advance directives exist for situations when that’s not possible. It is vital to establish them early and check them at five key moments:

  • Once a decade
  • A loved one’s death
  • Divorce
  • Diagnosis
  • Decline in activities

“This is not something you stow away in a file cabinet,” Hogan said. “It needs to be accessible. Give them to your family, your doctor and keep them at home.”

For more information on advance directives, visit http://www.nlm.nih.gov/medlineplus/advancedirectives.html.

You can also speak with a representative from Seasons Hospice, located at Weiss, by calling (773) 564-7300 or visiting their website at http://www.seasons.org/.

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