Advance Care Planning (ACP) is the process by which individuals make their wishes about their future healthcare known to their loved ones and their healthcare team should they become unable to communicate those wishes themselves. ACP also involves selecting someone to make healthcare decisions on the individual’s behalf if they become unable to make those decisions.
While ACP can be a challenging topic to bring up with family and friends, participating in these conversations can ultimately bring great relief to the individual, their loved ones, and the healthcare team, because the person’s wishes for their medical care are made clear.
ACP is not just for older people or people who are ill. Unforeseen circumstances can happen to anyone. Having an Advance Care Plan in place for adults (18 years +) can help ensure that people receive the type of medical care that is consistent with their wishes and values.
There are various, interchangeable terms that are used in reference to ACP, so getting clear on those terms and their meaning is a good place to start. These terms can differ from state to state, so be sure to know the terminology that your state recognizes.
An Advance Directive is a set of legal documents that make your wishes about the kind of healthcare you want to receive known to your loved ones and your healthcare providers. Importantly, the Directive can inform them of your preferences before you become ill. An Advance Directive also includes the designation of your Healthcare Agent who will make healthcare decisions for you should you become unable to make those decisions or speak for yourself. The Directive provides guidance to your Healthcare Agent and physicians when you become ill and unable to make, or communicate, your choices. You have the option to designate an alternate in the event your Agent is unable or unwilling to serve. At any time that you are mentally competent and able to communicate your wishes, you are free to verbally override your written Advance Directive and direct your own care.
A Living Will (also known as Advance Healthcare Directive, Medical Directive, or Personal Directive, depending on where you live) is a type of Advance Directive that documents your wishes for your healthcare/medical treatments at the end of life. It is a legal document that states the care that you wish to receive and do not wish to receive if you are unable to communicate your wishes due to your medical condition.
A Medical Power of Attorney (may also be referred to as Healthcare Agent, Healthcare Proxy, Healthcare Surrogate, Healthcare Representative, Healthcare Attorney-in-Fact, or Patient Advocate, depending on where you live) is another type of Advance Directive that designates the person you choose to make healthcare decisions on your behalf when you are unable to make those decisions.
Choosing a Medical Power of Attorney
For some people, it is obvious and clear who will be a “good” Medical Power of Attorney for them. For others, it may take some serious thought and consideration. The person who may serve you best in this role may not necessarily be your spouse, sibling, parent, adult child, or close friend. Following are just a few things to consider when choosing your Medical POA:
Choose someone who is legally eligible to serve as your Medical POA (your Medical POA must be 18 years or older, cannot be your healthcare provider, cannot be an employee of your healthcare provider -- unless this person is your spouse or a close relative).
Choose someone who can remain calm and think clearly during a time of great stress.
Choose someone with whom you’ve had a conversation about your wishes and preferences, and who will follow through on those wishes and preferences even if they disagree with you.
On a practical note, select someone who is likely to be available when you need them. While there are no guarantees, choosing someone who lives relatively close by makes good sense.
Here is a short video about selecting a Healthcare POA.
Completing a Living Will
It is advisable to work with a lawyer you trust to prepare your Living Will, Will, Power of Attorney and HIPPA Authorization. A lawyer will make your documents consistent with each other, so that conflicts do not arise later about who has what power, and conform them to your state's law. For example, you want a Power of Attorney who will work cooperatively with your Healthcare Agent to enable your wishes. Both Agents must understand how their respective powers and documents relate to each other and to your wishes. Payment for healthcare and final arrangements must be authorized by your Power of Attorney and Executor. An Advance Directive you prepare yourself might be fine as a stand-alone, but not coordinate with your overall Plan and other Agents/documents. Nevertheless, you are not legally required to go to a lawyer to prepare your Advance Directive.
Below is Pennsylvania’s Advance Healthcare Directive (Living Will):
When completing the Living Will, you will be asked to consider a variety of medical, life-sustaining measures, and whether you or not want those interventions. It’s a good idea to have a conversation with your lawyer, healthcare provider, your Medical POA, your Durable POA (a Durable POA allows the Healthcare Agent to take action when someone is incapacitated), and other people whom you trust to talk through these options and determine your preferences in advance of completing your Living Will.
Once your Advance Directive and Appointment of a Healthcare Agent is complete review these with your loved ones, your Healthcare Agent, your physician, your Durable POA, your Executor, and keep the originals in a safe place that can be easily located (not in your safe deposit box which cannot be quickly accessed). Tell your Healthcare POA where in your home your Advance Directives are located. Make copies of your Advance Directives and give them to your Healthcare POA, your healthcare providers, your local hospital (where you might likely be taken in case of an emergency), and family members/loved ones.
Advance Care Planning is not a “one and done.” Take the time to review your Advance Directives annually and when you have any major events in your life such as a change in relationship with your Medical POA, a change in your health status, a major trip, etc.
Talking about the inevitable and creating an Advance Care Plan can be intimidating for some people, but having these conversations and participating in the planning process may actually alleviate anxiety and bring comfort. Sometimes taking the first step can be the hardest part!
Advance Care Planning Resources:
There are many resources related to ACP. Here are just a few:
American Bar Association, Commission on Law and Aging, Toolkit for Advance Healthcare Planning
Please note -- This article is simply a guide and a means of providing some information and resources about Advance Care Planning (ACP). The contents of this article are not exhaustive. Please consult with your attorney and healthcare provider as you go through the ACP process so that your unique needs are met. This document is not intended to provide legal advice and does not create an attorney client relationship.