Key Aspects of Advanced Care Planning

Once you have considered and discussed your wishes for future care, there are additional steps you can take to ensure you receive the care you want if you are unable to communicate it yourself.

Health Care Proxy

A health care proxy is the person who speaks on your behalf if you can’t make your own health care decisions. Your health care proxy can talk with members of the care team and read medical records to help make decisions about tests, procedures, and treatments if you became too sick to make them yourself. All adults aged 18 and older are recommended to fill out a health care proxy form to name the person who can make health care decisions for them in the future event of an unexpected illness, accident, or expected decline in health.
There are three steps to choosing a health care proxy:

  1. Picking a person.
  2. Having a conversation with that person.
  3. Adding that person’s information to your official documents

 

MOLST – Medical Orders for Life-Sustaining Treatment

MOLST is a medical order form (similar to a prescription) that relays instructions between health care professionals about a patient’s care. MOLST is based on individuals’ right to accept or refuse medical treatment, including treatment that might extend life. MOLST is not for everyone. In Massachusetts, patients of any age with a serious advanced illness may discuss filling out a MOLST form with their clinician. A MOLST form becomes effective immediately upon signing and is not dependent on a person’s loss of capacity.

The process before filling out MOLST requires discussions between the signing clinician (physician, nurse practitioner or physician assistant), the patient, and family members/trusted advisors. Considerations include the patient’s current medical condition and prognosis, possible benefits and risks of treatments, and the patient’s values and goals for care. After these discussions, the MOLST form may be filled out and signed by the clinician to instruct other health professionals about the use of life-sustaining treatments for the patient, based on the patient’s own decisions. A Living Will is not a medical order in some states, for example Massachusetts.

Code Status – What does it mean?

Sometimes your medical team has to make decisions around invasive life prolonging procedures or therapies, and it is helpful for patients and their care givers to understand aspects of this care and share their wishes in regard to that care. Code status refers to the type of treatment a person would or would not receive if their heart or breathing were to stop. The code status is located on the MOLST form but is also confirmed when patients are admitted to the hospital. The four basic categories, commonly referred to as resuscitative efforts are:

  • CPR (Cardiopulmonary Resuscitation) – includes providing chest compressions and breaths
  • Defibrillation – Electrical shock via pads or paddles
  • Cardiac Arrest Medication – Medications intended for when a person’s heart has stopped beating
  • Intubation and Mechanical Ventilation – The placement of a breathing tube connected to a ventilator if a person cannot breathe on their own

Other Aggressive Care Treatments

  • Dialysis – The placement of a  dialysis catheter connected to a machine to remove fluid and toxins from the body when kidneys no longer function properly
  • Tube-feeding – Providing nutrition and/or fluids via feeding tube if a person can no longer take anything by mouth.

 

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