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Advance Care Directives: Do it for those you love

If you are unable to communicate, others are left to struggle with medical care decisions. How will they know what is the right thing to do?

Advanced Care Directives

Claire Pace, MSN, APRN, talks about advance care directive documents with NCCC Director Mark Israel, who has his documents on file.

It's the situation no one wants to imagine: a medical condition leaves you unable to communicate. Do you want doctors to use machines to help you breathe? Resuscitate you if your heart stops? Caregivers want to follow your values and beliefs, but loved ones often face the hard choices alone. They struggle to do the "right thing," and sometimes they can't agree on what that is. Who decides?

Not just about you: a thoughtful gift for loved ones

"Many people do not realize that in New Hampshire and Vermont there are no legal statutes that identify 'next of kin,'" says Peggy Plunkett, DHMC APRN. "An advance directive does that. Possibly 50 percent of our ethics consultations could be eliminated if every patient 18 and over had an advance care directive on file."

All adults can benefit from thinking about what their health care choices would be if they are unable to speak for themselves. These decisions can be written down so that others know what they are. Advance directives come in two main forms: a "healthcare power of attorney" (or "proxy" or "agent" or "surrogate") documents the person you select to be your voice for your healthcare decisions if you cannot speak for yourself; a "living will" documents what kinds of medical treatments you would or would not want at the end of life.

Identify a decision maker, have your wishes readily available on file

Norris Cotton Cancer Center is working to have a legally executed advance directive (AD) or an advance care planning note (ACPN) directive on file in a readily retrievable location for each patient receiving care at the center.

"The most important aspect of an advance directive is naming a proxy decision maker who will know the patient's values and wishes if the patient no longer has the capacity to make decisions," said Claire Pace, MSN, APRN, Instructor of Medicine, Geisel School of Medicine. Pace is leading a new initiative to increase patient documentation at all NCC locations (Lebanon, Nashua, St. Johnsbury, and Manchester) from the current 45 to 80 percent.

April 16th is National Healthcare Decisions Day (NHDD), a national campaign to make more people think about advance care planning. DHMC is encouraging all employees to complete their own advance directive, so they can have conversations with patients and help them complete their advance directives.

Where do I start with Advance Care Planning?

What is Advanced Care Planning?

  • Attend "A Fresh Look at Advance Directives & Advance Care Planning: From Chore to Key Quality Improvement Strategy,"NCCC Grand Rounds on Tuesday, April 2, from noon to 1 p.m. Ira Byock, MD, Professor of Anesthesiology, Professor of Community and Family Medicine, Professor of Medicine and Claire Pace, MSN, APRN, Instructor of Medicine, Geisel School of Medicine will present (live/archived webcast, podcast).
  • Lead by example! The theme of National Healthcare Decisions Day on April 16th is "Leading by Example." DHMC is encouraging all employees to complete their own advance directive, so we will be better equipped to answer questions and help patients complete their advance directives. More information is available at the Office of Care Management, or visit:
    • NH Advance Directives: The New Hampshire Foundation for Healthy Communities offers an array of health-related community initiatives for the state. Download their Advance Care Planning Guide for all the necessary documents.
    • VT Advance Directives: Put It in Writing: Maintained by the American Hospital Association, this comprehensive site about advance care planning offers forms to download, reference information, a glossary of terms related to the process, as well as Spanish language content
  • Have a conversation about end of life care with loved ones. The Conversation Project website has tips and tools to help you get started.

April 01, 2013