ADVANCE DIRECTIVES


Advance Directives:
A Gift You Can Give

If you do not have an advance directive in place and you become seriously ill or injured, your doctors, hospital staff and loved ones will do the best they can. However, without clear direction from you, your loved ones my have to guess what you would want. If there is any uncertainty about your wishes, care could be delivered that may not be consistent with your wishes. If you want people to know—and follow—your wishes, you should talk with them about your preference and have a written and signed advance directive in place.


What is Advance Care Planning?

Advance Care Planning is a process of making decisions about the care you would want to receive if you become unable to speak for yourself. These are your decisions to make, and are based on your personal values, preferences, beliefs, and discussions with your loved ones. 

Your wishes and preferences can be stated in an Advance Directive - a legal document that goes into effect only if you are incapacitated and unable to speak for yourself. This could be the result of a disease or illness; or an unexpected event or accident causing a brain injury no matter how old you are. By creating an Advance Directive, you have the opportunity to plan ahead for what type of care you would want and it helps others know what your wishes and preferences are for health care. Advance Care Planning can help reduce stress and anxiety for individuals and their families, and provide you with the opportunity to receive the type of health care that you would want when you are not able to speak for yourself.


Advance Care Planning includes:

* Selecting a substitute decision-maker {healthcare agent} who will make decisions on your behalf if you are unable to speak for yourself.

* Deciding what types of treatment you would want or not want if you were diagnosed with a life-limiting illness; or a permanent brain injury. It might help to talk with your medical provider about how your current health conditions might influence your health in the future.

* Getting information on the types of life-sustaining treatments that are available. In considering treatment decisions, your personal values are key.

* Reflecting on your values and goals and what is important to you.

* Putting your wishes and preferences in writing by completing an Advance Directive.


Advance Directives - Common Questions & Answers

1. What is an Advance Directive?

An Advance Directive is a written document that allows you to:

- Give instructions about any aspect of your health care

- Choose a person to make health care decisions for you (health care agent)

- Give instructions about specific medical treatments you do or do not want

- State your hopes and wishes for end-of-life care

- Give other instructions, including organ donation, etc.

2. What is a healthcare agent?

An agent is an adult that you give the authority to make health care decisions for you, as provided in your Advance Directive.

3. Who should I appoint as my agent?

Your agent should be someone you know and trust, who knows how you feel about medical treatment, who understands your beliefs and values, and who is willing to carry out your wishes.

4. What if I have questions about any medical treatments?

You should talk to your medical provider or some other medical professional that can tell you about various kinds of medical treatments, services, procedures, or life-sustaining care.

5. Can I still make my own health care decisions after I have signed an Advance Directive?

Yes. You will be able to make your own health care decisions as long as you are capable of doing so. Your Advance Directive only takes effect when you become incapacitated; or when the conditions you have identified in the Advance Directive are met.

6. Do I need an attorney to complete an Advance Directive?

No. It is not necessary to have an attorney involved in completing an Advance Directive. However, if you have questions about legal matters, you may want to consult an attorney.

7. After I sign an Advance Directive, what should I do with it?

You should keep your original document in a place that is easy to find in the event that you become unable to make or communicate your decisions. You should provide a copy of your Advance Directive to your medical provider and any other health care agencies who are providing care for you, such as a hospital. Also, provide a copy to your health care agent(s), close family members, other significant people who may need to know your health care preferences.

8. How often should I review my Advance Directive?

Advance Care Planning is an ongoing process. You should review your Advance Directive as your health, goals and values may change. It is recommended to review your Advance Directive when the "Five D's" occur:

Decade - when I start each new decade of my life.

Death - whenever I experience the death of a loved one.

Divorce - when I experience a divorce or other major family change.

Diagnosis - when I am diagnosed with a serious health condition.

Decline - when I experience a significant decline or deterioration of an existing health condition, especially when I am unable to live on my own.

If you make changes to your Advance Directive, you should complete a new Advance Directive form, and provide copies to the people as indicated above.

9. Where can I obtain an Advance Directive form?

Advance Directive forms and Advance Care Planning Information Packets are available at Cavalier County Memorial Hospital & Clinics. Advance Directive forms are also available online at www.honoringchoicesnd.org


LIFE-SUSTAINING TREATMENTS

CPR Facts - What You Should Know: 

What is CPR? CPR is done for you by someone else. It can include:

* Breathing into your mouth and pressing on your chest.

* Electrical shock and drugs to try to start your heart.

* A tube to help you breathe.

Does CPR work?

CPR does not help as much as most of us think. CPR works best if:

* You are healthy with no illness.

* It can be given to you within a few minutes of when your heart or lungs stop working.

CPR does not Work as well if: 

* You have chronic health problems.

* You have an illness that can no longer be treated.

* You are older and weak.

If you are in the hospital and get CPR, you have a 22 percent chance of it working and leaving the hospital alive. If you are older, weak, and living in a nursing home, CPR works less than 3 percent of the time.

What else can happen with CPR?

If CPR does help to get your heart and lungs to work, it usually has side effects. 

* Your lungs are weakened and you will need to be on a breathing machine for a period of time.

* You will need to he cared for in an ICU.

* You may have brain damage.

* You may have damage to your ribs.

You should talk to your medical provider about these side effects.

If you want to try CPR, you should talk about what results you would expect and what your goals would be. If you decide that you do not want to try CPR, you need to tell your doctor and family.


Ventilator:

Ventilators are machines that help you breathe. A tube connected to the ventilator is put through the throat into the trachea so the machine can force air into the lungs. Putting the tube down the throat is called intubation. Because the tube is uncomfortable, medicines are often used to keep you sedated while on ventilator. If you are expected to remain on a ventilator for a long time, a doctor may perform a tracheotomy. During this bedside surgery, the tube is inserted directly into the trachea through a hole in the neck. For long-term help with breathing, a trach is more comfortable, and sedation is not needed. People using such a breathing tube are not able to speak without special help because exhaled air does not go past their vocal cords.


Artificial nutrition and hydration: 

If you are not able to eat, you may be fed through a feeding tube that is threaded through the nose down to your stomach. If tube feeding is still needed for an extended period, a feeding tube may surgically inserted directly into your stomach.

If you are not able to drink, you may be provided with IV fluids. These are delivered through a thin plastic tube inserted into a vein.

Artificial nutrition and hydration can be helpful if you are recovering from an illness. However, studies have shown that artificial nutrition toward the end of life does not meaningfully prolong life. Artificial nutrition and hydration may also be harmful if the dying body cannot use the nutrition properly.


Advance Care Planning assistance:

Cavalier County Memorial Hospital & Clinics is offering assistance with Advance Care Planning. If you have questions or need help with completing an Advance Directive, CCMH can help you. 

CCMH has an Advance Care Planning Certified Facilitator who is available to meet with you and assist with the process of completing an Advance Directive. 

If you are interested in Advance Care Planning or would like assistance with completing your Advance Directive, contact the CCMH Advance Care Planning Certified Facilitator at 256-6189 to schedule an appointment.