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Choosing a Healthcare Advocate

Perhaps one of the most important decisions to be made in the advance care planning process is choosing a healthcare advocate. A healthcare advocate can be a family member, close friend, or someone else you trust to make decisions in accordance with your wishes but should be designated through legal documentation.

It’s important to have ongoing discussions with your healthcare advocate about your future medical choices, including specifics about when and what medical treatment options you prefer, because your decisions may change over time. In order to legally empower this person to carry out healthcare wishes and decisions when you are unable to do so please fill out a medical power of attorney. Some questions to ask a potential advocate include:

  • Do you understand my wishes, values, and treatment goals?
  • Are you willing to follow my preferences even if others disagree?
  • Can you uphold my wishes even if others challenge my decisions?

Putting Your Wishes into Writing

Creating a written document that states your preference for future and end-of-life medical care is an essential part of the advance care planning process. Advance directives, also referred to as a living will or medical power of attorney, are formal legal documents and generally meet state requirements when completed by an adult over age 18.

  • Medical Power of Attorney: A medical power of attorney allows you to legally appoint a healthcare advocate to make medical decisions on your behalf. It can be enacted even if you are not diagnosed with a terminal disease. It is not required that an attorney draft a medical power of attorney.
  • Directive to Family, Physicians, and Surrogates: One of the most common documents, this directive informs your family, physicians, and surrogates of your instructions about your medical treatments should you be unable to communicate your wishes. Sharing this information with your family and medical team is a ‘gift,’ and it empowers you to direct your care, when you can’t communicate to direct your care.
  • Do Not Resuscitate (DNR) Order: A do not resuscitate (DNR) order, is separate from a directive to family, physicians and surrogates. An Out-of-Hospital Do Not Resuscitate (OOH DNR) order is a legal document that formally requests that if your heart stops or you stop breathing that you do not wish for medical intervention. If you do not want life-sustaining measures outside of the hospital, you will need to complete an OOH DNR order, which is signed by your physician.
  • Medical Order for Scope of Treatment (MOST)/ Physician Order for Scope of Treatment (POST): The MOST/POST form may be called different things in different states. It is a portable medical order where the plan for the level of care and treatment the patient wants is documented. These fall into three categories: full, selective, and comfort care interventions. Documentation includes instructions regarding cardiopulmonary resuscitation, intubation and mechanical ventilation, and artificial nutrition. MOST/POST forms are appropriate for individuals with a serious illness or frailty near the end of life.

Most states have forms available to document future healthcare wishes. Varieties of commercial forms are available. Less formal, but possibly effective forms include documented conversations with a physician and a handwritten letter signed by you. Additional information on specific state requirements is available through your local state department website or the National Hospice and Palliative Care website.