Advance Care Planning
Advance care planning (ACP) is the process of helping you, the patient, and your family understand, reflect, and communicate your goals and values in the event of an accident, sudden illness, or chronic condition that prevents you from speaking for yourself. ACP does not require a formal document to be created but is the first step in thinking about what medical treatment you would want.
This can feel like a daunting task, and something that’s easy to put off. After all, it’s not comfortable or easy to think about a medical emergency or death. We believe this can also be a very empowering task. You can make these important and thoughtful decisions now and live with the assurance that your wishes will be carried out if in the future you’re in a situation where you’re not able to advocate for yourself. Plus, we will be by your side helping in any way you need us to as you make these important decisions.
What is an advance directive?
Simply put, an advance directive is a legal way for you to make your medical treatment preferences known – and to ensure they’re followed. They capture the type of medical care you want to receive, guiding your family, friends and health care providers as they confidently carry out your medical wishes even if you’re not able to communicate them at some point.
Here in North Carolina, you have six options when it comes to advance directives. We’re here to walk you through the process to make sure you have everything in place to share your medical preferences down the road.
Living Will
Also known as a treatment directive, a living will explains whether or not you want certain types of life-prolonging medical treatments, such as breathing machines and tube feeding, if you experience at least one of the following:
- An incurable condition that will end your life within a short period of time
- Unconsciousness with the expectation that you won’t regain consciousness
- Advanced dementia or other substantial and irreversible loss of mental function
Health Care Power of Attorney
In a health care power of attorney document, you name someone to be your health care agent. That means they’re able make health care decisions for you when you can’t speak for yourself. You may choose any competent adult who’s not your paid health care provider.
Your health care agent can make decisions about your care such as:
- Choosing doctors and facilities
- Determining mental health treatment
- Reviewing and sharing your medical information
- Starting or stopping life-prolonging measures
Advance Instruction for Mental Health Treatment
An advance instruction for mental health treatment expresses your wishes for mental health care if you’re not able to communicate them. Mental health treatment includes:
- Admission and retention in a facility for the care or treatment of mental illness
- Electroconvulsive therapy (ECT or “shock therapy”)
- Psychoactive drugs (medications that affect your central nervous system)
Additional forms may be used to document your treatment preferences as part of the advance care planning discussions with your healthcare providers:
Medical Order for Scope of Treatment (MOST)
A MOST form is a doctor's order that helps you keep control over medical care at the end of life. The form (usually on bright pink paper) tells emergency medical personnel and other health care providers what medical treatment you would want if you could not speak for yourself. A MOST form is signed by:
- The patient or patient’s health care agent
- Physician
Do No Resuscitate (DNR)
A DNR is a medical order written by a doctor. It instructs health care providers not to do cardiopulmonary resuscitation (CPR) if a patient's breathing stops or if the patient's heart stops beating.
Goals of Care
Your provider or other healthcare staff might document your goals and values in a form called a Goals of Care. This form is not a legal or medical document but rather helps you and the healthcare staff review what is most important to you. A Goals of Care form includes the following questions:
- Tell us about your current understanding of your health or chronic illness.
- What are your short and long-term goals? Are there any future special events for milestones that are particularly important to you?
- If your health were to decline and you needed more aggressive care to prolong your life would you want things like cardiopulmonary resuscitation (CPR), mechanical ventilation or intensive care?
Do I need an advance directive?
Our answer is a resounding YES. All adults (18 years and older) benefit from creating advance directives, because everyone deserves to have their medical wishes carried out. Because life comes with unknowns, we think it’s wise to take the time to complete an advanced care directive AND to share those wishes with loved ones and your care provider no matter your age, life stage or current health status.
You are able to update your advance directives at any time, as long as you’re mentally competent, so they can evolve over time as needed.
Help Completing Forms
Your health care provider can help you have Advance Care Planning conversations and complete documents. If you need more immediate assistance, you can count on our thoughtful, supportive Triad HealthCare Network professionals to help you make health care decisions that fit your values, beliefs and priorities.
Signing & Storing Your Advance Directives
In order for your Living Will and Health Care Power of Attorney to be valid, your signature on each of those two documents must be witnessed by:
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- Two people who aren’t related to you, who aren’t entitled to any portion of your estate at death, or who serve as your health care providers, and who do not have a claim against your estate
- A notary public
Keep your completed, signed advance directive forms where they can be found when needed, such as in your medical records at home, as well as in your hospice, home health care or nursing records if applicable. Give copies to your spouse and next of kin, and have conversations with them about your wishes, too. You also may wish to give copies to your adult children, close friends, clergy or pastor, or other caregivers.
Communicating with Your Health Care Team
With a health care power of attorney and an advance directive, you can stay in control of your care and ensure your wishes are followed by loved ones and caregivers. THN has partnered with Vynca, Inc., to provide a technology platform where patients’ wishes can be stored and shared regardless of where you receive care.
If you have an advance care planning document you would like to share with your medical team, bring your document to your next appointment and ask to have it uploaded to your medical record.
Hospice & Palliative Care Resources
For information on palliative or hospice care, visit Authora Care Collective and Hospice Care of the Piedmont to learn more.
