PHYSICIANS AND ADVANCE CARE DIRECTIVES
Generally, end-of-life discussions are not a routine part of care for health care providers. Some doctors may avoid the topic of Advance Care Directives due to fear of causing pain and bearing bad news to patients and their families. Physicians may be unfamiliar with advance directive laws.
Considering the patient's and the family's goals is always crucial in medicine, but is especially so near the end of life. Goals are not defined so much by cure rates as by what is important to a patient and the family. Good palliative care recognizes that hope might exist, but also tries to establish achievable goals and hopes for patients. Documentation is necessary to establish the patient's wishes and to ensure those wishes are carried out.
LIVING WILL VERSUS DURABLE HEALTH CARE POWER OF ATTORNEY
Living Wills and Durable Health Care Powers of Attorney can provide physicians with guidance and an identified decision-maker when a patient cannot fully participate in health care choices.
In a Living Will, a person indicates his preferences for medical care in the event of a serious accident or illness. This document describes the measures a person wants or does not want as a means of prolonging life. There are limitations to a Living Will because it does not permit a health care provider to stop a feeding tube or artificial means of prolonging life.
A Durable Health Care Power of Attorney designates an agent who can make such decisions for a patient should he become unable or incapacitated. The Arizona Attorney General web site has a thorough explanation of who cannot be an agent, but it must be someone other than a relative by blood, adoption or marriage who would not benefit from the patient's death. The agent needs the ability to make an independent decision, so he or she cannot be a health care giver. A patient can name an alternate agent in case the first choice is unable, unwilling or unavailable to act.
DISCUSSING ADVANCE CARE DIRECTIVES WITH PATIENTS
Anyone 18 or older can and should draw up a Living Will and complete the form for a Durable Health Care Power of Attorney. Physicians can play an important role in initiating and guiding the advance care planning process by making it a routine part of care for all patients. The state Attorney General's web site has downloadable forms for a Living Will and a Durable Health Care Power of Attorney that physicians can print for their patients. This process ultimately can benefit patients because it can provide them with a sense of control and peace of mind with regard to their future health care.
Also, physicians should not overlook developing their own advance care directives if they plan to advise patients to prepare them.
Notice: The Arizona Medical Board is providing this information only for patient convenience and should not be interpreted as legal advice nor relied upon to properly execute the referenced documents. Readers are encouraged to obtain legal advice to answer any questions.