Critical Care

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    End-of-life planning has changed in a number of ways. According to a Pew Research Center study from January 2006, "More Americans Discussing -- and Planning -- End-of-Life Treatment," more people have a living will than in the past. Between 1990 and 2005, the number of people who said they have a living will increased from 12% to 29%.

    The Pew Research Center also found:
    • Over a period of five years, 42% of Americans had a friend or relative suffer from a terminal illness or coma, and for a majority of these people, the issue of withholding life-sustaining treatment came up.
    • An overwhelming majority of the public supports laws that give patients the right to decide whether they want to be kept alive through medical treatment.
    • By more than eight-to-one (84%-10%), the public approves of laws that let terminally ill patients make decisions about whether to be kept alive through medical treatment.
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    The federal Patient Self-Determination Act (PSDA) requires that all Medicare-participating healthcare facilities inquire about and provide information to patients on advance directives. It also requires these facilities to provide community education on advance directives. All healthcare facilities are required to:
    • provide information about healthcare decision-making rights
    • ask all patients if they have an advance directive
    • educate their staff and community about advance directives
    • not discriminate against patients based on an advance directive status
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    The following resources are useful for family conversations about advance directives:
    • The Conversation Project is dedicated to helping people talk about their wishes for end-of-life care. The focus is on generating conversations about healthcare wishes with family members and ensuring individuals have thought through what they want at the end of life.
    • DeathWise is passionate about motivating people to talk about, make decisions, plan for the end of their lives and then documenting their wishes in an advance directive to ensure their preferences are communicated to their medical services providers, family and friends. Wise Conversations provides trained coaches to meet with and guide small groups of people through conversations about clarifying choices and the process of completing advance directives.
    • Engage with Grace helps people discuss what's important to them so their end-of-life experience is just as purposeful as the way in which they live their life. Their movement calls on people to engage in a blog rally every Thanksgiving and also has a call to action to participate in their One Slide project. The One Slide features just five questions designed to get the conversation about end-of-life care started with loved ones.
    • Coda Alliance has a "Go Wish Game," a card game that is a simple way to think and talk about what's important to individuals and their family members if someone becomes seriously ill.
    • LastingMatters helps any adult, at any age, compile, document and clearly communicate important information, intentions and wishes. The LastingMatters Organizer is a practical and comprehensive planning guide helping to reduce the costs, time, stress and family pressures associated with the death of a loved one.
    • My Gift of Grace is a conversation game for living and dying well. Designed as a fun, engaging way to start conversations with any group, the game is a tool suitable for players at all life stages.
    • The My Healthcare Wishes App is a smartphone application for storing advance directives and other important health information.
    • PREPARE, also referred to as PREPARE For Your Care, is an interactive website serving as a resource for families navigating medical decision making.
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    The following are places where you can find advance directive documents:
    • A|D Vault/MyDirectives -- Complete free advance directives online
    • Aging With Dignity (Five Wishes) -- Order online
    • Caring Connections -- Download free state-specific advance directives
    • Center for Practical Bioethics --Download for free
    • Compassion & Choices -- State-specific advance directive material
    • DeathWise -- Download free state-specific advance directives
    • Everplans -- Checklists and free state-specific advance directives
    • Lifecare Advance Directives -- Advance directive support documents
    • MedicAlert Foundation -- Advance directives for all 50 states
    • National Resource Center on Psychiatric Advance Directives
    • Project GRACE
    • The Will to Live Project
    • The Patients’ Rights Council
    • U.S. Living Will Registry
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    If you decide to stop dialysis treatment, you or your surrogate may want to make sure the following items are in order:
    • Your will
    • Signed advance directive (living will, durable healthcare power of attorney or healthcare proxy) complying with your state law
    • A durable power of attorney, complying with your state law, naming someone to act on your behalf on all matters other than medical (e.g., legal, financial, banking and business matters). Your power of attorney must be a durable one in order to stay in effect even if you become unable to make your own decisions or if you die.
    • An inventory, including the location of your bank, brokerage and other financial accounts, stock and bond holdings, real estate and business records, medical and other insurance policies, pension plans and other legal papers
    • Names, addresses and telephone numbers of your attorney, accountant, family members and other loved ones, friends and business associates who should be notified of your death or who may have information that will be helpful in dealing with estate affairs
    • A statement about your preference for funeral/memorial services, burial or cremation instructions and decisions about organ and tissue donation
    • Written, video- or audio-taped message to family members and other loved ones, business associates and friends
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    The role and responsibilities of a medical surrogate, as well as the types of decisions the surrogate may make, may vary from state to state, depending on the laws of that state. Generally, the surrogate must follow your wishes. For more information about naming a surrogate and about the laws in your state, you may speak with an attorney or the social worker at your unit. To obtain copies of the forms used in your state, you may contact your local or state bar association. 
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    You can name someone (such as a spouse, adult child or close friend) to make medical decisions for you, such as stopping dialysis, in case you are no longer able to make these decisions for yourself. This is done by filling out a form called a healthcare proxy or a durable healthcare power of attorney. The person you name to make medical decisions for you is called a surrogate. It is important to make sure the person is willing to act on your behalf and that he or she knows your short- and long-term goals, values and what treatments you would or would not want to have if you were not able to speak for yourself. It is helpful if you complete a form called a treatment-specific living will, which will give your surrogate clear directions about your wishes regarding stopping dialysis and/or other medical treatments. 
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    AEverplans answered
    A power of attorney (POA) is someone you appoint to make legal and financial decisions on your behalf should you be unable to do so. Since your power of attorney potentially will be handling your legal and financial affairs, you’ll want to choose someone who either has some experience in these fields or has the necessary qualities to handle the decisions that may fall to him or her.

    A power of attorney should be a person with the following characteristics:
    • Attention to detail
    • An understanding of his or her duties, and a commitment to taking those duties seriously
    • An understanding of finances and perhaps business
    • The ability to collaborate with attorneys, accountants and other parties, if necessary
    In addition, a power of attorney should be someone you trust, who you believe understands your values and will act in your best financial and legal interest.
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    AEverplans answered
    Many legal professionals encourage naming a durable power of attorney rather than a springing power of attorney. That's because if the terms of incompetence are not specified in a springing power of attorney, a formal proceeding to determine incompetence must be held. The person you named as your springing power of attorney may not be able to act until this process is complete. 
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    AEverplans answered
    A springing power of attorney (POA) becomes effective upon a specific date, event or condition. Usually, this “condition” is a declaration of mental incompetence by a doctor. Because the POA “springs” into effect upon a declaration of incompetence, it is important to state in the springing POA paperwork what qualifies as incompetence -- and who must make the declaration. This person is usually your doctor.

    Because a springing power of attorney does not go into effect immediately, it can limit the agent's access to your finances. This can create less of a chance that the person you name as your power of attorney will commit fraud against you or steal from you.