FAQ for Advance Care Planning

Frequently Asked Questions

What is Advance Care Planning?
Advance Care Planning (ACP) is a process of reflection, communication, and sometimes education that allows individuals to determine their personal goals for future healthcare in the context of their values and beliefs. This lets us plan ahead and prepare for future needs and medical care (preferably before a crisis) and to choose someone to speak for us in the event that we are not able to speak for ourselves. Thoughtful ACP involves communication of these wishes through conversations and documents.

Why is Advance Care Planning important?
At some point in our lives, 50% of us will be unable to make medical decisions for ourselves. This is why intentional appointment of an informed healthcare agent (or “medical decision-maker”) is so crucial to making sure we get the care we want. In Colorado, if you have not appointed a healthcare agent in writing through a document called a Medical Durable Power of Attorney (MDPOA) the law allows any “interested party” to become involved in decisions about your healthcare. This is why thorough advance care planning is so important.

Isn’t my spouse (or parent, or adult child) automatically my healthcare decision-maker?
No. Without documentation of a healthcare agent, physicians in Colorado are legally obligated to listen to all “interested parties.” The vast majority of other states have healthcare proxy statutes that do follow a spouse-adult child-parent protocol for decision-makers.

Do I need to go to a lawyer?
No. An MDPOA is a simple form that can be filled out by individuals without the help of an attorney. Once dated and signed, it is a legal document. There is an optional second page where you can have your signature notarized and/or have your agent sign as well, but this is not necessary. We have these forms available and can help you with the process.

My (children/spouse/parents) don’t want to talk about this.
We are not talking about death and dying, but about living fully and addressing quality of life issues while we are fully able to do so. Most people don’t want to “be a burden” to their families, and yet failing to make your wishes clear often results in a terrible burden to family; they are left without direction or understanding of your needs and choices. Families feel guilty, and the legacy is often one of stress and pain. We have tools and resources, “conversation starters”, videos and prompts that can help you engage with your loved ones in meaningful conversations around future care.

I’m young and healthy! I don’t need to do this.
This is exactly the time to start simple Advance Care Planning. Everyone over 18 should have a Medical Healthcare Agent. The process of talking to loved ones about your personal values is a very rich experience at any age.

But I’ve done all this. I have a Do Not Resuscitate order.
Chances are you do not actually have a DNR. You likely have a document called a Living Will or Advance Directive with certain checklist care choices (like DNR, no CPR, no intubation etc.). These are effective under very limited circumstances. You must be unable to make decisions AND two physicians must agree that you are terminal or in a persistent vegetative state.
An effective DNR or “no CPR” directive must be signed by a physician. We can teach you about the MOST form, as well as the Colorado Directive to Withhold Cardiopulmonary Resuscitation. Both are physicians’ orders for treatment.
Outside of the hospital, emergency responders must see either of these documents otherwise CPR will be initiated. It’s their job.
If you have written advance directives, but have not engaged in conversations with loved ones about your future choices, there may be great misunderstanding, stress and strife in times of crisis. Sound Advance Care Planning involves a true communication process with loved ones and clinicians; we specialize in opening up the circle for dialogue and then closing all loops with the healthcare system.

I want to die at home. How can I make this happen?
Research shows that 80% of us want to die at home, and yet 80% die in institutions (hospitals, skilled nursing facilities, etc.). The best way to assure your wishes are respected is advance care planning with family – thoughtful values-based conversations and the appointment of a fully informed decision-maker.

Consider these facts …

  • 90% of people say that talking with their loved ones about end-of-life care is important.
  • 27% have actually done so. (Source: The Conversation Project National Survey (2013)
  • 60% of people say that making sure their family is not burdened by tough decisions is extremely important.
  • 56% have not communicated their end-of life wishes.
  • 80% of people say that if seriously ill, they would want to talk to their doctor about wishes for medical treatment toward the end of their life.
  • 7% report having had this conversation with their doctor.
  • 82% of people say it’s important to put their wishes in writing.
  • 23% have actually done it.

Source: Survey of Californians by the California HealthCare Foundation (2012)

I, like many of my colleagues, have come to realize that while we are developing more and more ways to extend life we have also provided water and nutrients to a forest of unrealistic expectations that have real-time consequences for those frail bodies that have been entrusted to us.

Dr. Louis M. Profeta

Emergency Physician, Indianapolis, Indiana