End-of-Life Decisions: Care Instructions

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Your Care Instructions

It can be hard to live with an illness that cannot be cured. But if your health is getting worse, you may want to make decisions about end-of-life care. Planning for the end of your life does not mean that you are giving up. It is a way to make sure that your wishes are met. Clearly stating your wishes can make it easier for your loved ones. Making plans while you are still able may also ease your mind and make your final days less stressful and more meaningful.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor or nurse call line if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

What can you do to plan for the end of life?

  • You can bring these issues up with your doctor. You do not need to wait until your doctor starts the conversation. You might start with "I would not be willing to live with...." When you complete this sentence it helps your doctor understand your wishes.
  • Talk openly and honestly with your doctor. This is the best way to understand the decisions you will need to make as your health changes. Know that you can always change your mind.
  • Ask your doctor about commonly used life-support measures. These include tube feedings, breathing machines, and fluids given through a vein (IV). Understanding these treatments will help you decide whether you want them.
  • You may choose to have these life-supporting treatments for a limited time. This allows a trial period to see whether they will help you. You may also decide that you want your doctor to take only certain measures to keep you alive. It is important to spell out these conditions so that your doctor and family understand them.
  • Talk to your doctor about how long you are likely to live. He or she may be able to give you an idea of what usually happens with your specific illness.
  • Think about preparing papers that state your wishes. This way there will not be any confusion about what you want. You can change your instructions at any time.

Which papers should you prepare?

Advance care plans include papers that tell doctors how you want to be cared for at the end of your life in case you are in a coma or cannot communicate. You do not need a lawyer to write these papers. Ask your doctor or your local public health unit for information on how to write your advance care plan. They may have the forms for each of these types of papers. Make sure your doctor has a copy of these on file, and give a copy to a family member or close friend.

  • Consider a do-not-resuscitate order (DNR). This order asks that no extra treatments be done if your heart stops or you stop breathing. Extra treatments may include electrical shock to restart your heart or a machine to breathe for you. If you decide to have a DNR order, ask your doctor to explain and write it. Place the order in your home where everyone can easily see it.
  • Consider naming a substitute decision-maker. This allows you to name a person to make decisions about your care if you are not able to. Most people ask a close friend or family member. Talk to this person about the kinds of treatments you want and those that you do not want. Make sure this person understands your wishes. If this person is not the substitute decision-maker named in your advance care plan, also talk with your substitute decision-maker.

These papers are simple to change. Tell your doctor what you want to change, and ask him or her to make a note in your medical file. Give your family updated copies of the papers.

Where can you learn more?

Go to http://www.healthwise.net/ed

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