Today is National Healthcare Decisions Day

April 16 has been designated National Healthcare Decisions Day, a day to raise awareness of and encourage advance care planning. National Healthcare Decisions Day is a collaborative effort of national, state, and community organizations to ensure that all adults with decision-making capacity are empowered to communicate and document their healthcare decisions.

Many people find it difficult to discuss end-of-life care, either their own or that of a loved one. Although most Americans have thought about their preferences regarding end-of-life care, less than one third has a living will. These conversations should not be put off; no one can predict just when he or she will be rendered unable to participate in their own healthcare decisions. The process of clarifying your own wishes, choosing a health care agent to speak for you when you’re no longer able to speak for yourself, sharing these decisions with loved ones and your doctor, and writing them down on Advance Directive forms will ensure that your treatment is carried out in the manner your desire and will make treatment decisions easier for your family and loved ones when the time comes.

End-of-life care decisions can be complicated. A discussion with a healthcare professional may help you begin thinking about the possibilities that may arise, can assist your understanding of your options, and help you clarify your values and preferences and the level of medical intervention you may want. Originally, CMS included advance care planning in the list of additional services that could be included in the Medicare annual wellness visit, provided for by the Affordable Care Act. However, last January CMS rescinded this element, citing a lack of opportunity to consider the wide range of views held on the subject. Nonetheless, patients can still turn to healthcare facilities for additional information and guidance in their advance care planning. The Federal Patient Self-Determination Act requires that all healthcare facilities participating in the Medicare program provide information to patients on Advance Directives and health care decision-making rights.

Some avoid engaging in advance care planning because they mistakenly believe that an attorney’s assistance is required to prepare the documents. Although an attorney can assist you, sample forms are available on the Illinois Department of Public Health website, which you may fill out yourself and which require just a few signatures, as specified by law. The site provides an overview of Illinois law and explains the signatures and number of witnesses required for each type of advance directive. Illinois allows for three types of advance directives: health care power of attorney, living will, and mental health treatment preference declaration. If you do not want to use the sample forms provided, you can also write your own health care power of attorney or living will, as long as the required signatures are still obtained.

Some Advance Care Decisions to think about:

• Healthcare Power of Attorney: enables you to choose an “agent” who will make healthcare decisions for you if you become unable to do so yourself. As long as you remain able to make your own healthcare decisions, you will be able to continue to do so. Unless you specify a time limit, the power of attorney will remain effective until your death, but you are free to cancel it at any time
• Living Will: informs your healthcare provider whether you want death-delaying procedures used if you have a terminal condition and are unable to make your own healthcare decisions. Unlike the healthcare power of attorney, a living will only is effective if you have a terminal condition. The living will may be cancelled at any time.
• Mental Health Treatment Preference Declaration: enables you to say whether you can to receive electroconvulsive treatment (ECT), psychotropic medicine, or may be admitted to a mental health facility when you have a mental illness and cannot make healthcare decisions for yourself. You can also use the form to choose someone who will make your mental health treatment decisions for you (called an “attorney-in-fact”).
• Do-Not-Resuscitate Order (DNR order): A medical treatment order that states that if your heart and/or breathing stops, CPR will not be attempted. Illinois has developed a Uniform DNR Advance Directive form which contains two parts: an advance directive that is consented to by the patient or his or her legal representative and witnessed by one adult, and a physician’s order, signed by the physician. All appropriate medical treatment other than CPR will still be rendered to you. Illinois’ Uniform DNR form is currently being updated to reflect the standards of the National Physician Orders for Life-Sustaining Treatment program.

After making any end-of-life treatment preference decisions and filling out any advance directive documentation, it is your responsibility to make sure that loved ones, doctors, attorneys, and/or any agents you appoint are aware of your wishes. You may want to give each a copy of your advance directive(s) as well. Although advance care planning can be an emotional and difficult process, taking the time now to have these discussions will make certain your loved ones and physician are aware of and understand your treatment preferences, and will ensure your wishes can be carried out when the time comes.

Amanda Swanson

LL.M. in Health Law Candidate

Loyola University Chicago School of Law