End of Life Care


‘End of Life Care’ Guide

The Patient Self-Determination Act (PSDA) of 1991 is a federal law designed with the purpose to ensure that a patient’s right to self-determination in health care decisions be communicated and protected. Through ‘Advance Directives’ – (the Living Will and the Durable Power of Attorney – DPOA)– the right to accept or reject medical or surgical treatment is available to adults while competent, so that in the event that such adults become incompetent to make decisions, they would more easily continue to control decisions affecting their health care (https://www.ncbi.nlm.nih.gov/pubmed/10141946). This act suggests, but does not require, that patients take advantage of their rights by signing a health care directive that becomes part of their medical life. Unfortunately, many people have not discussed End-of- Life Care planning during their healthy years and it becomes difficult to put these plans into place in the middle of a crisis. Below is an explanation of what documents you will need to consider creating for yourself and ways in which you can make them available when you need them:

The general definition of End-of- Life Care Planning is simply a set of written instructions that lets others know what kinds of care you want if you become seriously ill or are dying. There are a number of considerations to make when putting these documents together and we will touch upon several of them here. Utilizing the guidance of an Aging Life Care Manager™ and/or an Estate Attorney can give you the guidance you’ll need to make the right decisions for your End-of-Life Care Planning.

Some of the important considerations might be whether you wish to have cardiopulmonary resuscitation (CPR) in the event your heart stops beating. This can include chest compressions, electric shock (defibrillation), or the use of various medications in order to restore the heart to a normal rhythm. Other kinds of life-saving treatments that may be considered are the use of a breathing tube (endotracheal intubation) if a person has a severe breathing problem; the insertion of a feeding tube might be recommended if a person is unable to take anything by mouth for any extended period of time. While it is in your power to make these decisions ahead of time, these decisions can be changed at any time, up to and including during a time of crisis.

Each state can regulate End-of Life Care planning documents, and can decide whether they will honor a document produced in another state. It is always a good idea to have your End-of- Life Care planning documents reviewed by an estate attorney if you have recently moved to a new state. And it is prudent to have an attorney review/update your documents in the event that
your circumstances have changed – e.g. a spouse dies, children who would otherwise have been available to speak to a medical professional have moved away, your relationships with those you have listed as proxies has changed and you no longer wish to have them speak for you, etc. The documents described below are recognized by the state of California:

Advanced Care Directive: – This is a document by which a person makes provisions for healthcare decisions in the event that in the future, he/she becomes unable to make those decisions. There are two kinds of documents that are part of an Advance Care

  1. Living Will – This is the oldest type of healthcare directive and it is an expression of an individual’s wishes regarding the use of life-saving/sustaining measures, in the event he/she is terminally ill or comatose and has no reasonable expectation of recovery. They are final instructions to family, caregivers, physicians and friends about a person’s end-of- life care wishes. It can therefore instruct a physician to withhold or withdraw medical interventions from its signer if he/she has a terminal condition and is unable to make decisions about medical treatment.
  2. Durable Power of Attorney for Healthcare (DPOAH) – This is a document in which the signer designates an agent (or Healthcare Proxy) to make healthcare decisions if the signer is temporarily or permanently unable to make such
    decisions. This type of Durable Power of Attorney does not give the designee(s) power to make decisions for financial matters, only those decisions relating to healthcare.

Prehospital Do-Not- Resuscitate (DNR) Request Form – This is an official state form created by the California Emergency Medical Services Authority, in concert with the California Medical Association, for the purposes of instructing emergency personnel regarding a patient’s decision to forego resuscitative measures in the event of cardiopulmonary arrest. This form is used prior to being admitted to a hospital.

Do-Not- Resuscitate (DNR) Form – Do not resuscitate (DNR), also known as “no code” or “allow natural death,” is a legal order written either in the hospital or on a legal form to withhold cardiopulmonary resuscitation (CPR) or advanced cardiac life support (ACLS), with respect to the wishes of a patient in case their heart were to stop or they were to stop breathing. When you are admitted to a hospital, your doctor can add a DNR order to your medical record. DNR orders do not stop all treatment, it only means that CPR or a ventilator will not be used. Most hospitals should honor the Prehospital DNR Request Form. If not, they will have you or your healthcare proxy sign a new one.

Physician’s Order for Life Sustaining Treatment (POLST) Form – This document contains the medical order that gives seriously ill patients more control over their care by specifying the type of medical treatment a patient wishes to receive at the end of life. These forms are traditionally kept in one’s medical file by a physician if they are being treated for a life-threatening condition, are hospitalized with a life-threatening condition, or are living in an assisted living environment where the resident’s wishes for end-of- life care must be known in the event of an emergency and the patient is unable to
communicate those wishes.

In addition to creating an Advance Care Directive and other End-of- Life Care planning documentation, it is important to keep in mind the following:

  • Always keep copies of these documents handy. We never know when a crisis might occur and it is important that we have access to these documents when we need them. While it is important to keep the originals in a safe place, always have copies of them in a file that you can grab in a hurry. Never keep the copies in a safe deposit box!
  • For those you have named as Healthcare Proxies, make sure they have several copies of your documents – and encourage them to keep them handy in the event you have an emergency.
  • Finally, it is important that you let those whom you have designated to help you in a time of crisis to know what your wishes are. Besides giving them a copy of these documents, having a heartfelt and detailed discussion with them about their importance in this role, can make handling these issues much easier for the both of you.

If you are in the (South Bay) Los Angeles area and are ready to take steps to plan for your End-of- Life Care, please give us a call at (424) 26-AWLCS and we will help you put these important plans in place.


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