How do I let people know about my care decisions?

There are written documents that can tell your doctors and loved ones about your wishes for end-of-life care. They are instructions that will help guide the treatment you get. They’re important to have in case you would get a serious medical problem that keeps you from making decisions or speaking for yourself.

Advance care forms you can prepare before you become seriously ill

The 1^st type of written medical documents are legal forms you can prepare at any time of your life, usually before you have a serious medical problem. Sometimes people get a lawyer to help them prepare these forms.

• Advance directive, also called a living will
  It’s good to prepare and sign this form before you have a serious medical problem. The form instructs EMTs (emergency staff), doctors, and hospital staff about the treatment you wish to receive. Keep it on your refrigerator and in your purse or wallet so EMTs can see it in an emergency.

Your advance directive may include the topics covered by the legal forms listed below, or you can prepare these forms separately:

• Healthcare proxy, also called a durable power of attorney for health care
  This form lets you name another person to make healthcare decisions for you when you aren’t able to. You can name a family member, close friend, or another trusted person. You should discuss your care decisions with the person you name as your healthcare proxy and give them a copy of your advance directive or other legal medical forms.

• DNR (do not resuscitate) order
  This form tells hospital staff that you don’t want them to use CPR to try to restart your heart if it stops beating.

• DNI (do not intubate) order
  This form tells hospital staff that you don’t want them to hook you up to a breathing machine if you can’t breathe on your own.

• Organ and tissue donation
  This is a decision about if you would want your loved ones to donate your organs when you die. If you would like to be an organ donor, doctors could collect your organs (such as your heart, kidney, or liver) and give them to a person who needs a new organ to live.In most states, when you get or renew your driver’s license they will ask if you want to be an organ donor – then they’ll put the answer on your driver’s license. There is no cost to donate your organs, even if doctors need to use machines to keep your organs ready for transplant.

  If you sign a DNR or DNI order to not use machines, doctors may not be able to use your organs. So you need to decide which is more important: having a DNR or DNI, or donating your organs.

Advance care forms you can prepare if you get a serious illness

The 2^nd type of written medical documents are legal forms, called medical orders, that you can prepare after finding out you have a serious illness. The medical order can give the same instructions as your advance directive.

• POLST (physician order for life-sustaining treatment) form, also called a MOLST (medical order for life-sustaining treatment) form
  This form is a medical order, signed by your doctor, for treatment you want when you are very ill. It lists your care decisions and becomes a part of your medical record.Some states do not yet legally recognize medical orders, so check with your doctor or lawyer before you prepare one.

How do I share my care decisions?

After you set up your advance care plan, share it with others

• Share your care decisions with family and friends. Tell them about your choices and give a copy of your advance directive or other written documents to a few people – especially to your healthcare proxy.
• Give a copy of your advance directive or other documents to your doctor.
• Keep copies for yourself in a safe place. Tell people close to you where you keep these copies (especially your healthcare proxy who can make healthcare decisions for you when you aren’t able to).
• Think about your decisions from time to time in case you change your mind about the care you want. You can always make changes to your advance directive or other documents. If you do, be sure to replace the older versions you gave to your loved ones and your doctor.