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 gives clarity to your patient advocates regarding what your preferences are for healthcare should they have to speak on your behalf. Having an AD relieves the burden from your family members and patient advocate because they will not have to guess what types of care you would want. They will be able to advocate on your behalf to the medical community.
Why should I have a “facilitated” conversation? I can do it myself with a free advance directive document from the internet.
It is true, you can download free advance directive forms from the internet, including this site. A facilitated conversation however, helps you clarify your personal values, beliefs which will guide you as you determine your preferences for healthcare, including end of life care. The meeting moves at your own pace, and there is no pressure to influence your treatment preferences. Our skilled facilitators can give guidance on topics such as CPR, hospice and palliative care, funerary decisions, and more.
An AD that meets Michigan’s statutory requirements is legal whether or not you use an attorney. Be sure to follow the directions for document completion. The Making Choices Michigan form meets Michigan requirements.
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. Click here (link) for more information on being a patient advocate.
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.
Once the AD and the “Accepting the role of patient advocate” forms are completed, then do the following:
make a copy for your advocate and give it to the person
store your original copy in a convenient location, not a safety deposit box! It is important that your family or friend can get to the original should it be needed.
discuss your AD preferences with your medical provider. Give that person a copy of your AD for your medical file.
discuss your AD with your family and friends. You may want to give them a copy of your AD. Encourage them to complete their own AD!
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.
How much does a facilitated conversation cost?
It's FREE. Making Choices Michigan is a non-profit agency funded from a variety of sources. There is no cost associated with downloading the form or completing a facilitated conversation.
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.
You may also bring your advocate to the first meeting if you have already identified who will speak for you.