by Timothy Gieseke, MD, CMD

As a senior physician who has over-seen the death of many patients, I have seen many persons struggle with making important decisions for their seriously ill loved ones. In my own situation, I have regrets about some of the decisions we made for my father during his final hospitalization in 2001. Later, as I developed more expertise helping patients with Advance Care Planning (ACP) for future emergencies, I was able to help my mother have the kind of death that she wanted.

As you think about this subject for yourself and those you might be asked to represent in an emergency, I recommend thinking now about what’s important to you and about how to best document those values. You should also consider your risk tolerance, and how much burden you’re willing to tolerate for the anticipated benefit of a proposed intervention. While this may all seem too theoretical, I highly recommend spending some time personalizing your approach to potential future illness and then identifying a hierarchy of substitute decision makers who are willing to represent you. Having done this, you are now ready to complete an AHCD (Advance Health Care Directive). (A free generic version can be found on the internet along with FAQ.) If you have a trust fund, your attorney has likely done this. How old is this document? Is it current?

For myself, I have found www.mydirectives.com to be a helpful tool for completing an AHCD and documenting your thinking on this subject. It automatically involves your substitute decision makers and emails you the first of every year to update it. In addition, www.prepareforyourcare.com is an excellent web site with many videos of various health emergencies that helps you and your decision makers to become “battle tested” for a future emergency.

For those in the last chapter of their life, the Compassionate Care Coalition of California has developed a pink colored POLST (Physician Order for Life Sustaining Treatment) form that works well in emergencies. Both my mother and father-in-law greatly benefitted from this form. It can be found at http://capolst.org/polst-for-patients-loved-ones/

For more detailed information on this subject, visit the Coalition for Compassionate Care of California website, which has a wealth of helpful resources.
Remember, the foundation for this planning is not only the above resources, but also good conversations with your clinical team and family.

I’m hopeful for good ACP planning for you and your patients in 2017.