Here we are at week three of my Advance Care Planning (ACP) soapbox speech. We have addressed the issue of making the decision to “start the conversation”, why ACP is important for you and your family/friends, and appointing a substitute decision-maker (SDM).
Now it is time to sit down with a pen and paper or your computer and put your choices in writing. It is not legally necessary to have written instructions as long as your SDM is officially appointed through a POA for Personal Care, and you have made them aware of your life choices. Personally I would recommend a written document as it can be a very emotional time for your SDM and being able to visually reference your choices and wishes can be comforting.
So what kinds of personal care choices can be made? You can express your wishes about anything related to your personal care – where you want to live, what you want to eat and wear, what kind of health care you want, how you prefer to be groomed and how you want your safety ensured. Your SDM must follow your expressed wishes wherever possible. If it is impossible to follow your wishes, your SDM must act in your best interests based on your known values and resources.
Your family and friends may need encouragement and time to accept the idea of advance care planning before they are ready to hear about your wishes for the future. Many people do not like to talk about illness, mental incapacity or death. Tell them how important it is to you to talk about this now. Talk through potential disagreements on care options, as this may prevent challenges later on. Review your wishes on a regular basis with your SDM and make sure your family, friends and care providers are aware of any changes.
There are some circumstances when an injury or illness cannot be reversed or cured. In some cases medical procedures, called interventions, will only prolong life and delay death. These procedures could include mechanical ventilation, tube feeding, intravenous fluids or other treatments. Would you want to be treated with these types of medical procedures?
You do not have to specify decisions for all possible situations; in fact, this would be impossible to do! It is more important that your SDM knows you, your values and beliefs and feels confident in acting on your behalf. Some questions to consider when preparing your ACP are:
- What do I value most in terms of my mental and physical health? (being able to live independently, being able to recognize others, being able to communicate with others)
- What would make prolonging life unacceptable for me? (not being able to communicate with those around me, being kept alive with machines but with no chance of recovery, not having control of my bodily functions)
- When I think about death, I worry about certain things happening. (struggling to breathe, being in pain, being alone, losing my dignity)
- If I were nearing death, what would I want to make the end more peaceful for me?
- Do I have any spiritual or religious beliefs that would affect my care at the end of life?
You can find the ACP workbook online at www.advancecareplanning.ca (use the Ontario version) or we do have some available at our Belleville office. Call Julie for more information at 613-969-0130.