By Towana Ernst, APN, FNP-BC, Palliative Care Consulting Service, OSF Saint Francis Medical Center
Sometimes the best way to introduce a topic is through an analogy. Most adults have experienced an event in their life that required planning. For example, imagine a wedding. Your best friend is getting married and has asked you to meet and discuss her plans for that special day. Your role is to carry out her plans. When the time comes and the wedding occurs, although you have arranged everything, the event will unfold to be her dreams come true.
Most adults have experienced unplanned events. Illness or accidents occur. The diagnosis and treatment may be as simple as a trip to the emergency department (ED) for some stitches or perhaps an antibiotic for an infection. However, the illness or accident may be life-threatening, requiring very intense treatment or, in fact, the patient may not survive. Members of the health care team must rely on family to know the patient well if he or she is no longer able to make their own health care decisions. The staff will ask, “Is there a health care power of attorney?”
What is a health care power of attorney? Do all adults need to have one? Does this document have to be prepared by an attorney? If there is no one named, who makes the decisions? These are only a few of the questions that may come to mind and perhaps we can provide answers.
A search of the Internet will provide the basic document, which is called “health care power of attorney” (HCPOA) or power of attorney for health care. The state of Illinois has created a document titled “Illinois Statutory Short Form Power of Attorney for Health Care.” It is legal in all 50 states. The document may be printed and then completed by the person wishing to appoint a HCPOA. Any individual over the age of 18 would benefit by completing this document since none of us knows when someone may need to speak for us.
Most of the HCPOAs have four important sections. First, the name of the person who is filling out the form and whose health care decisions are noted is required. Next, the name of the agent they are appointing to make health care decisions for them if they are determined unable to make decisions. There are standard components in the documents such as but not limited to: do you wish to have your organs donated; are there any procedures or machines that you are certain you do not want to have started in your care (example: ventilator, feeding tube, dialysis); if at any time your agent is not available or is unwilling to make decisions, is there a successor (or two) that you would like to take over? There is also a section where you, the owner, are able to provide a more focused direction to your agent. Typically, there are three paragraphs and you are asked to initial one of them. Those paragraphs name specific guidelines you would like your agent to follow when making decisions on your behalf. The owner of the HCPOA must sign it and date it. Your signature is witnessed by someone who is not named in the document and is not directly responsible for your health care.
While this document, the HCPOA, is a signed agreement between you, as the focus of the document and your agent/successor, it must be accompanied by a discussion. This is a good time to have a talk centered on the decisions you would want made for you if there comes a time when you are no longer able to direct the health care team. Talk with your agent about the activities that you enjoy in life, what brings you happiness, the type of spiritual care you believe would comfort you, and your plans for your body after death (i.e., funeral, burial, cremation, organ donation). This discussion document should be reviewed together with your agent.
The individual that accepts the appointment of agent may need to be at the bedside when you are unable to speak. They will face many questions from the health care team and those questions may include discussions about medications, treatments, procedures, even life-sustaining treatment or end-of-life conversations. In answer, the agents often use phrases like, “my dad said he never wanted…” or “my sister did not want…” As members of the health care team, we see the confidence that HCPOAs exhibit when they are able to share the decisions as they were expressed to them by the patient.
Preparing your plan in advance is not meant to be stressful. It is an opportunity for you to make your decisions when your thought process is clear and you are able to identify your values.
For more information, visit osfhealthcare.org/supportive-care or call 309-624-6004.
Photo credit: Wavebreakmedia Ltd/Thinkstock