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Getting Started with Advance Care Planning: Conversations and Documents to Make Your Health Care Wishes Known

Kerry O'Connor, APNP, palliative care nurse practitioner, decided to ask her parents the same question she asks many of her patients. What kind of health care would they want if they were ever unable to speak for themselves? 

"I was completely shocked by their responses," said Kerry. "I want to do the best by them. I'm so glad I asked." 

While the topic may be difficult to bring up with your loved ones, there are many tools to help you and your loved ones start thinking and talking about your wishes. (See the resources list at bottom.) Some of these tools are known as living wills, which let people put their wishes for medical treatment in writing. Living wills are not legally recognized in Massachusetts, but can still be a helpful guide for those making decisions on your behalf. 

Two documents that are recognized in Massachusetts, and have counterparts in other states, are the health care proxy and Massachusetts Medical Orders for Life-Sustaining Treatment (MOLST). 

Health Care Proxy

The health care proxy form allows you to appoint someone, known as an agent, to make health care decisions for you if you are unable to communicate those decisions yourself. The agent only gets to make these decisions if a clinician has evaluated the patient and determined that the patient no longer has the ability to make these decisions. The decision-making power returns to the patient when their condition improves enough that they are once again able to make and communicate their decisions.  

The form, instructions and discussion questions are available from the Massachusetts Medical Society. If you ever want to change your agent, simply complete a new form. Make sure your agent either has a copy or knows where you keep it. You may also want to give a copy to your physician, hospital or health plan, and others who may be involved in handling your affairs, such as your lawyer. Be sure to talk to the person you appoint as your agent about the types of medical care you do and do not want.  

MOLST 

Kerry recommends that people with a serious illness or anyone who is advancing in years also have a MOLST form. (Many other states use a form known as POLST, Physicians Orders for Life-Sustaining Treatment.) 

The form allows you to document what life-sustaining treatments you do or do not want, such as using a ventilator if you can't breathe on your own. The document is a medical order that relays your decisions between health care professionals. The MOLST form will need to be signed by a physician, nurse practitioner, or physician assistant after a conversation about the goals for care between the signing clinician and the patient. Like the health care proxy, you can make changes to the MOLST form at any point in time. Talk to your medical provider to learn more. 

Kerry views these documents and conversations about health care wishes as "good self-care, because it's helping reduce any stress your family might have in trying to determine what you want. ...There are a lot better outcomes emotionally for patients and families when they've done this kind of advanced work."

Additional Resources

Five Wishes helps you have conversations about and document your wishes. The booklet includes a health care proxy form.  

The Conversation Project offers a conversation starter kit available in English, Spanish, Mandarin, French, Hebrew, Korean, Russian, and Vietnamese. They also offer a starter kit for families and loved ones of people with Alzheimer's and other types of dementia, tips for talking to your doctor, and advice for choosing or being a health care proxy.  

National Healthcare Decisions Day has a long list of resources for expressing and documenting your wishes.  

This information is intended for educational purposes only. For legal, health, tax, or financial advice, please contact your professional advisors. 
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