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| Advance Care Planning Guide |
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A process to think about, talk about and plan for end-of-life care.
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Information contained below provided by Foundation for Health Communities: www.healthynh.com |
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Why Advance Care Planning?
Making decisions about medical care is not always easy — especially now that machines can keep patients alive even when there is no hope for recovery. It's your right to participate in and plan for your care. But at some point, you may be unable to make your own health care decisions. That's why it's important to think and talk about your feelings and beliefs with your loved ones — long before critical decisions must be made.
This guide provides you with information about creating two "advance directives" — legal documents that state your preferences about medical care. Please read this guide carefully and discuss it with your family, doctor, patient representative, chaplain, or other caregiver.
You don't need to have an advanced directive if you don't want one — no hospital, nursing home, doctor, nurse, or insurance company can require you to have advance directives to provide you with services. However, it's a good idea to have advance directives in place if you want to make sure that your family and health care providers follow your wishes about your medical care. It will also make it much easier for your family should you become unable to participate in decisions about your care. They will not have to agonize over difficult decisions, uncertain of what you would want them to do. And, if family members or your health care providers disagree about what is right for you, advance directives will help you avoid having decisions made by the courts, which can be difficult, time consuming, and costly.
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Your thoughts and answers to these questions can help provide you and your caregivers peace of mind. |
Values
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What gives your life its purpose and meaning? |
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What do you value most about your physical or mental well-being? For example: Do you love the outdoors? To read or listen to music? To be aware of who is with you? Your ability to see, hear, taste, or touch? |
Family/Friend Relationships
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Who among your family and friends are important in your life? |
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Have you talked about your choices with your loved ones and with those who will be around you when problems arise or death comes close? |
Spiritual/Religious Beliefs
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How would you describe your spiritual or religious life? |
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How does your faith, community, church, or synagogue support you? |
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Do you have religious beliefs about medical treatment? |
Medical
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What health problems do you fear in the future? |
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Under what conditions would you want the goals of medical treatment to change from trying to continue your life to focusing on your comfort? |
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Would you want a hospice team or other form of palliative care offered to you? |
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How does cost influence your decisions about medical care? |
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How do you feel about life-sustaining treatment, such as kidney dialysis? Do you want CPR used to revive you? Where do you prefer to receive medical treatment? |
Making Plans
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If you could plan it today, what would the last day or week of your life be like? Where would you be? Who would be with you? What would you be doing? |
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What general comments would you like to make about dying or death? |
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What will be important to you when you are dying (comfort, no pain, family present, music, prayer, being touched or held, etc.)? |
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Are you interested in organ or tissue donation? |
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Are there people to whom you want to write a letter, or for whom you want to prepare a taped message, perhaps marked to be opened at a later time? |
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What are your wishes for a memorial service: songs or readings you want, or people you hope will participate? |
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Would you prefer to be buried or cremated, or do you have no preference? Have you contacted a funeral home? |
Questions About Advance Directives
What is an Advance Directive?
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An advance directive is a legal document — written before you have an incapacitating illness — which allows you to state your preferences about medical care. The State of New Hampshire recognizes two forms of advance directives: a Durable Power of Attorney for Health Care and a Living Will. |
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What is a Durable Power of Attorney for Health Care (DPOAH)?
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A Durable Power of Attorney for Health Care is a document in which you name another person to act as your health care agent to make medical decisions for you if you become incapacitated. You can include instructions about which treatments you do or do not want, or how long you want to try possible treatments. If you do not want artificial feeding or hydration, New Hampshire law requires that you say so in your document. |
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What is a Living Will?
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A Living Will instructs your doctor to give no life-sustaining treatment if you have a terminal condition or are permanently unconscious. If you do not want artificial feeding or hydration, New Hampshire law requires that you say so in your document. |
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Do I need both a Durable Power of Attorney for Health Care and a Living Will?
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It is a good idea to have both documents because they serve two different purposes. A Durable Power of Attorney for Health Care takes effect when you become unable to make decisions — for instance, during surgery, or even when you become temporarily unconscious. A Living Will takes effect only when there is no hope for recovery. Under New Hampshire law, if the terms of your advance directives conflict, the Durable Power of Attorney for Health Care will overrule the Living Will. |
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What is artificial feeding?
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Artificial feeding means intravenous feeding or feeding through a tube. It does not include the natural process of eating foods. There is little, if any, pain or discomfort in providing artificial feeding. |
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What is artificial hydration?
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Artificial hydration usually means intravenous fluids. It does not include the natural process of drinking fluids. There is little pain or discomfort in providing artificial hydration. |
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How does the Durable Power of Attorney for Health Care relate to a "do not resuscitate" order"?
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Life sustaining treatment includes cardiopulmonary resuscitation (CPR); however, you should talk to your doctor and health care providers about their practices with respect to issuing and implementing DNR orders. |
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What don't these advance directives accomplish?
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These advance directive documents only cover certain important health care issues. They do not provide for many other important personal planning matters. For example, these advance directives do not allow your health care agent to handle your general, financial, and decision-making matters if you become unable to legally handle your own affairs. A "General Durable Power of Attorney" is recommended to handle this situation, and may avoid the expense and stress of getting a guardianship through the Probate Court. You should discuss this and other related important non-health care issues with your attorney. |
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Do I need to renew my advance directives?
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Advance directives do not need to be renewed. However, if you want to change something in either your Durable Power of Attorney for Health Care or your Living Will, you must complete a new document. You might want to re-examine your health care wishes before each annual physical exam, at the start of each decade of your life, after any major life or medical change, or after losing your ability to live independently. New Hampshire's Living Will law was revised in 1991. If you have an advance directive that was executed before April 2001, your document is valid, but it will look different from the current one. |
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Can I revoke my advance directive?
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You can revoke or cancel your advance directive orally or in writing at any time. A divorce action will automatically revoke your Durable Power of Attorney for Health Care if your spouse is your health care agent and you have not named an alternative in your document. |
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What if my advance directive was executed in another state?
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Your out-of-state advance directive is valid in New Hampshire as long as it was legally executed in the other state. However, it will be interpreted using New Hampshire law. |
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Who should have copies of my advance directive?
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Copies of your documents should be with your doctor, your hospital, your family, and the person you select as your health care agent or your long-term care facility. Ideally the original documents should be stored where you keep your other important legal papers such as wills, birth certificates, and social security cards. This way you will always have quick access to these important directives. |
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How will my health care providers know if I have an advance directive?
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You should tell your doctor, nurses, or other health care providers that you have an advance directive and provide them with copies for your medical record. Any time you are admitted to a hospital, you will be asked if you have an advance directive. If you know that you will be admitted to a hospital, you should bring copies of your documents with you. |
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Who can witness the signing of my advance directive?
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Your advance directive must be signed in the presence of two witnesses and a notary to be valid. Your health care agent named in your Durable Power of Attorney for Health Care, spouse, heir, attending doctor, or person supervised by your doctor may not serve as a witness. Only one of the two witnesses may be your health or residential care provider or one of your provider's employees. |
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Disclosure: Durable Power of Attorney for Health Care
This is an important legal document. Before signing it, you should know these important facts:
Unless you state otherwise, this document gives the person you name as your health care agent the authority to make any and all health care decisions for you when you are no longer capable of making them yourself. Health care means any treatment, service, or procedure to maintain, diagnose, or treat your physical or mental condition. Your health care agent, therefore, will have the power to make a broad range of health care decisions for you. Your health care agent may consent, refuse to consent or withdraw consent to medical treatment, and may make decisions about withdrawing or withholding life-sustaining treatment. Your health care agent cannot consent to or direct any of the following:
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Commitment to a state institution |
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Sterilization |
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Termination of treatment if you are pregnant and if withdrawing that treatment is deemed likely to terminate the pregnancy, unless the treatment will be physically harmful to you or prolong severe pain that cannot be alleviated by medication |
You may state in this document any treatment you do not want, or treatment you want to be sure you receive. Your health care agent's authority will begin when your doctor certifies that you are no longer able (lack capacity) to make health care decisions. If for moral or religious reasons you do not want to be examined by a doctor to certify that you lack capacity, you must say so in the document, and name someone who can certify your lack of capacity. That person cannot be your health care agent, or any person ineligible to be your health care agent. You may attach additional pages if you need more space to complete your statement.
If you want to give your health care agent authority to withhold or withdraw artificial nutrition and fluids (artificial feeding and hydration), your document can say so. Otherwise, your health care agent will not be able to direct that. Under no condition will your health care agent be able to direct the withholding of food and drink for you to eat and drink normally.
Your health care agent must follow your instructions when making decisions on your behalf. Unless you state differently, your health care agent will have the same authority to make decisions about your health care as you would have had, if those decisions are made consistent with state law.
It is important that you discuss this document with your doctor or other health care providers before you sign it, to make sure you understand the nature and range of decisions, which could be made on your behalf. If you do not have a doctor, you should talk with someone who is knowledgeable about these issues and can answer your questions. Check with your community hospital or hospice for trained staff. You do not need an attorney's assistance to complete this document, but if there is anything in this document you do not understand, you can ask an attorney to explain it to you.
The person you choose as a health care agent should be someone you know and trust, and must be at least 18 years old. If you choose your health or resident care provider (such as your doctor, or an employee of a hospital, nursing home, home health agency, or residential care home, other than a relative), that person will have to choose between acting as your health care agent or as your health or residential care provider; the law does not permit a person to do both at the same time.
You should consider choosing an alternate health care agent in case your health care agent is unwilling, unable, unavailable, or ineligible to act as your health care agent. Any alternate health care agent you choose will have the same authority to make health care decisions for you.
You should tell the person you choose that you want him or her to be your health care agent. You should talk about this document with your health care agent and your doctor, and give each one a signed copy. You should write on the document itself the people and institutions who will have signed copies. Your health care agent will not be liable for health care decisions made in good faith on your behalf.
Even after you have signed this document, you have the right to make health care decisions for yourself as long as you are able to do so, and treatment cannot be given to you, or stopped for you, over your objection. You have the right to revoke the authority granted to your health care agent by telling him or her, or your health care provider, orally or in writing.
This document cannot be changed or modified. If you want to make changes, you must make an entirely new document.
This power of attorney will not be valid unless it is signed in the presence of two (2) or more qualified witnesses, who must both be present when you sign and who will acknowledge your signature. The following persons may not act as witnesses:
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The person you have designated as your health care agent |
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Your spouse |
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Your lawful heirs, or beneficiaries named in your will or in a deed |
Only one of the two witnesses may be your health or residential care provider or one of your provider's employees.
For further information, please contact Jody Brusseau in Littleton Regional Hospital's Continuing Care Department, at (603) 444-9267.
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