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Easing the End-of-Life Transition with Advance Care Planning

We plan for so many transitions in life: births, graduations, weddings, retirement and moves. We want these transitions to go smoothly and be as comfortable and easy as possible.

How about planning for that end-of-life transition? It is daunting, it is sad to think about, and it is even scary, but it is also necessary.

Some of the hardest decisions are when loved ones, family members, friends or even neighbors have to make decisions about your medical care and needs when you cannot.

In the medical field, this end-of-life planning is called advance care planning. Advance care planning involves learning about decisions that might need to be made, considering the options and decisions ahead of time and informing others of the decisions that you want to be made. This allows an individual to express desires and wishes related to end-of-life care and may ease some burdens of loved ones when they know those wishes and desires.

Some of the decisions that need to be made are:

1. CPR: Cardiopulmonary Resuscitation. Cardiopulmonary resuscitation is attempting to restart the heart if it stops. It can involve repeatedly pushing on the chest with force, using medications and defibrillation or electric shocks in addition to air being forced into the lungs. In older adults and in individuals with multiple medical problems, CPR is not usually successful in prolonging life.

2. Ventilation use. A ventilator is a machine that can help breathing when the lungs are not working. A tube is placed through the mouth or nose and down the throat. It is connected to a machine that forces air into the lungs. This is uncomfortable and medicine is used to sedate the individual. The individual cannot talk with the tube in place.

3. Artificial Nutrition. If an individual cannot eat or drink, artificial nutrition may be offered. This can be given through an IV or through a feeding tube, a thin tube threaded through the nose and into the stomach. Studies have shown that artificial nutrition does not prolong life at the end of life and can cause further complications.

4. Comfort Care. Comfort care is doing and providing anything to make an individual comfortable at the end of life. This can include medication for pain, anxiety and nausea. It can include limiting testing and avoiding overnight stays in the hospital. It can also include spiritual and emotional counseling. It is a method to help an individual have a dignified end of life while relieving as much suffering as possible. This may be a time to include hospice care.

Once these decisions have been made, it is helpful to write down your wishes and share them with others. There are two main elements.

1. Living Will. A living will is a written document expressing your wishes for end-of-life care. If you cannot tell the doctors or your family your wishes because of severe illness, incapacitation or unconsciousness, this is a document they use to guide your care, per your wishes.

2. Durable Power of Attorney for Health Care. A durable power of attorney for health care is a legal document naming a proxy or surrogate. A proxy or surrogate is an individual that you name, who can make medical decisions for you if you are not able. This is an individual who is close to you, knows your wishes and values and is willing to make medical decisions for you when you are not capable.

This process can be overwhelming. There are several resources available to you to help you navigate these decisions. Your primary care doctor is an excellent resource to you. Make an appointment to discuss this. Don’t try to squeeze this into a regular appointment. Five Wishes is an excellent tool that provides a document and walks you through step by step. It introduces five important decisions, and allows you to learn about, think about and talk about, and then write down, your wishes. Find this document at Fivewishes.org.

This process is easier to face and to complete when you are able to think and discuss with others, rather than in an emergent health crisis. Planning ahead can make these emotional and difficult decisions easier for everyone. FBN

By Mary Porvaznik

Mary Porvaznik M.D. serves patients at Flagstaff Family Care. Call 928-527-4325 to schedule an appointment in Flagstaff and Sedona or visit FlagFamilyCare.com.

 

 

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