Advance Care Planning
Resources When Making Health Care Decisions
Do you remember when you used to gather around the roadmap and plan the route your family would take for their next journey?
When you make your personal healthcare wishes known through the use of Advanced Directives, you are mapping your own route, retaining control of, and protecting your right to request medical treatments or procedures you want - and refusing medical treatments or procedures you do not want if you lose the ability to make decisions yourself.
In New York State both a Health Care Proxy and Living Will are important documents in the Advance Care Planning process.
To help guide your planning, the New York State Department of Health offers a useful tool, Deciding About Health Care: A Guide For Patients And Families. The guide discusses the Health Care Proxy, Living Will and Do-Not-Resuscitate (DNR) orders in New York State.
Another useful resource developed by Aging With Dignity, entitled Five Wishes provides a guide to the advanced care planning decision-making process.
Appointing a health care agent
It’s not just for the elderly and it's easier than many people think.
- Select an adult you trust, such as a family member or a friend, as your agent on the New York Health Care Proxy form. You can also name an alternate agent who will take over if your primary agent is not available.
- Discuss your wishes with your health care agent. Talk about your values and beliefs.
- No one can plan for every scenario. The more your agent knows, the easier it will be for that person to make decisions for you.
- If you wish, you can use the Health Care Proxy form to write specific directions about the kind of care you want or don't want, just as you would in a Living Will or a Do Not Resuscitate (DNR) Order.
- If you like, you can simply write, "my agent knows my wishes."
New York Health Care Proxy
The New York Health Care Proxy is a legal document that lets you name someone to make decisions about your medical care—including decisions about life support—if you can no longer make decisions yourself. The Health Care Proxy form appoints a health care agent who will speak for you any time you are unable to make your own medical decisions, not only at the end of life. You are able to give your health care agent as little or as much authority in making health care decisions as you want.
New York Living Will
The New York Living Will lets you express your wishes about medical care in the event that you develop an incurable or irreversible condition that prevents you from making your own medical decisions. The Living Will becomes effective if you become terminally ill, permanently unconscious or minimally conscious due to brain damage and will never regain the ability to make decisions. Persons who want to indicate under what set of circumstances they favor or object to receiving any specific treatments use the New York Living Will.
Consent to a Do-Not-Resuscitate (DNR) Order
Under New York State Law, all adult patients can include a DNR Order in their medical chart. Patients can request a DNR order verbally or in writing if two witnesses are present. A DNR order will stop doctors, nurses, and other healthcare practitioners from initiating emergency procedures if your breathing or heartbeat has stopped. This includes mouth-to-mouth resuscitation, external chest compression, and electric shock, insertion of a tube to open your airway or injection of medication into your heart or open chest. Terminally ill patients may wish to have a DNR order to facilitate a natural, painless passing, or to avoid complications such as possible brain-damage after resuscitation.
Medical Orders for Life-Sustaining Treatments (MOLST)
In New York State, the MOLST form outlines specific end-of-life wishes and is recommended for those facing serious illness. You and your physician will fill out the form together after discussing treatment options. The MOLST form is kept with you at all times so that it is still in effect when you leave the hospital or if you change hospitals or transfer to another healthcare setting. The form indicates a patient's desires regarding resuscitation and medications to be given or withheld during end-of-life care.
The MOLST form does not replace a Health Care Proxy or Living Will, which are documents available for all healthy adults. All three documents (healthcare proxy, living will and MOLST) are recommended for those patients who are seriously ill. A MOLST form is similar to a DNR order, but it is more specific, completed with your physician and transferable to different locations like another care setting or home.