Advance Care Planning (ACP) is a process – a conversation, really – to help you clarify your health care values for future end-of-life care. The conversation includes you, your loved ones, a trained facilitator, and eventually your health care providers. The discussions will help you clarify your wishes regarding future medical care should you no longer be able to speak for yourself.
The Advance Directive (AD) is a document created as a result of Advance Care Planning discussions. It reflects your healthcare values and preferences for end-of-life care. For example, what are your preferences for pain management? When would you want life-support treatment versus allowing a natural death?
The AD also appoints a Patient Advocate to speak for you if you are deemed unable to make informed decisions about your care. Your attending physician and another physician or psychologist must agree, in writing, that you are incapable of making informed decisions. In Michigan an AD is often called a Patient Advocate Designation.
A Living Will expresses your healthcare values and preferences for end-of-life care with- out naming a Patient Advocate. Michigan law does not specifically authorize a Living Will as a separate document, but the information can be included in an Advance Directive (or Patient Advocate Designation).
Many people assume their doctor or family will know their preferences for care, but that is not necessarily the case. The AD document is a gift you give your loved ones, as well as yourself. If your loved ones are placed in a position of making medical decisions for you, they will not have to wonder what you would have wanted in a particular situation. They will be able to advocate on your behalf to the medical community.
It is true, you can download free advance directive forms from the internet. A facilitated conversation involves an appointment with a certified Respecting Choices® Facilitator. The Facilitator is skilled to help you clarify your personal values, beliefs and preferences for end of life care. The meeting moves at your own pace, and there is no pressure to influence your treatment preferences.
No, you do not have to notarize the AD. However, the witnesses of the AD must meet certain requirements (at least 18 years of age, not the patient’s advocate, spouse, parent, child, grandchild, sibling or presumptive heir; would not benefit from your death, not your healthcare provider nor an employee of a healthcare or insurance provider directly serving you at the time of signing the document).
A patient advocate is a person you select to make medical decisions for you, only if you are unable to participate in your own medical treatment decisions. The person you ask to be your advocate should be someone who will take the time to learn what type of medical treatment you would or would not want, and would be willing to actively advocate for you.
No. A durable power of attorney (DPOA) is a document in which you appoint a person (your agent) to handle your legal and financial affairs on your behalf. A Patient Advocate Designation is sometimes called a Durable Power of Attorney for Health Care.
The AD only goes into effect if and when you are too sick to communicate with your loved ones and medical team. For example, if you are in a coma from an accident or severe stroke, your patient advocate will be able to speak for you with your medical team. If you regain your ability to make and communicate medical decisions, your patient advocate would no longer be asked to make decisions for you.
You may change your AD at any time. It is a good idea to review your AD at least every five years, as your health condition changes, if your values about treatment change, or if your patient advocate is no longer able to serve in the role. Michigan law allows you to revoke your AD orally if you change your mind, but it is best to do it in writing.
If you do change your AD, be sure you inform your advocate, family, medical care provider and friends. Destroy the old document copies and give new copies to your advocate and medical provider.
Take a copy of your AD with you when you travel. In most states there are laws to protect and honor your wishes. If you live part-time in another state, you may want to consider filling out that state’s AD form.
There are two scheduled conversations. The first meeting will be between you and the certified Respecting Choices Facilitator. Most conversations last between 30-60 minutes. At the end of the first meeting you will have clarified your values and beliefs about medical treatment, and will have an idea of who you would like to be your advocate.
For the second meeting, you will return with your advocate. This is a time to be sure the advocate understands your wishes and clarify any questions. This conversation may last 30-60 minutes.
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Discuss. Decide. Document. Making Choices Michigan is a non-profit, community collaborative committed to determining a person’s end-of-life preferences, documenting those preferences in an advance directive (AD), developing a system for storing and retrieving the AD, and educating the healthcare community to honor a person’s AD to ensure that end-of-life preferences are respected.