Margie Atkinson, DMin, BCC, Director Pastoral Care, Ethics, Palliative Care at Morton Plant Mease, discusses what you need to know to set up your living will, advanced directives in case you are unable to speak for yourself and planning for end of life decisions.
Learn more about advance directives or download a free guide to advance directives today.
Selected Podcast
Understanding Advance Directives
Featured Speaker:
Margie Atkinson, DMin, BCC
Dr. Margie Atkinson is Director of Pastoral Care, Ethics and Palliative Care for Morton Plant Mease Health Care in Clearwater, Florida. Margie holds the Doctor of Ministry degree in Pastoral Theology from Brite Divinity at Texas Christian University and Master of Divinity degree from Southwestern Baptist Theological Seminary. Margie has worked in health care since 1994 as both a clinical professional chaplain and program administrator. She is a Board Certified Chaplain with the Association of Professional Chaplains and is a past president of this organization. She additionally participates nationally as a member of the Geriatric and Palliative Care Committee for the National Quality Forum (NQF) and on the Steering Committee and Writing Workgroup for the National Consensus Project Clinical Practice Guidelines for Quality Palliative Care, 4th Edition, set for publication in October of 2018. Transcription:
Understanding Advance Directives
Melanie Cole: Who would speak for you if you become unable to communicate your own health care wishes? What kind of medical care would you want if you were too ill or hurt to express your wishes? Healthcare planning is important for everyone regardless of your age or medical condition. My guest to tell us how to go about that today is Margie Atkinson. She's the director of pastoral care, ethics and palliative care at Morton Plant Meese Healthcare, part of Baycare Health System. Tell us first what is advanced care planning and explain a little bit about the different types and why it’s so important.
Margie Atkinson, DMin, BCCol: Advanced care planning refers to a number of different documents that represent a person’s healthcare wishes largely in the event that they are unable to speak for themselves. The CDC estimates about 70% of Americans don’t have an advanced directive, so the term advance care planning represents the process, the term advanced directive represents the type of document or the type of advanced directive that you have. There are two key types of advanced directives that we see as extremely important for anyone no matter what their age. The first is called a health care surrogate or it may be called a durable power of attorney for healthcare. Both of those documents involve me naming the person that we would like to make decisions for on our behalf if we were unable to make a decision for ourselves. It only goes into effect when I can't make my own decisions, but people don’t often realize there could be many different reasons that could happen. I want to name somebody A that knows me well, that understands my wishes in the event I can't speak, so that means we need to have conversations. I want to name someone, let them know what my wishes are, and make sure I have a good conversation with them so in the event that there tasked with making a decision, they know what I want. That person’s job is to make decisions that I would want, not what they want for me.
The second type of advanced directive that's also important is called a living will. A living will is a document that a person develops that only goes into effect in the event that I'm unable to make decisions and speak for myself. A living will is different from a health care surrogate. This document lets my caregivers and my family and anyone else who might have a need to know what my wishes are in the event that I have a terminal end-stage condition or in a persistent vegetative state. Terminal usually means that it’s a condition from illness or injury from which there's no chance of meaningful recovery. What people state in a living will might be, for example, I don’t want CPR if I have this terminal condition, I don’t want to have a tube down my throat or I don’t want a feeding tube if I'm in a terminal condition. What that means is that I may be expected to die soon. Those are some of the things that a person might put in their living will.
The neat thing about a living will too is that you can specify if there's something you do want to have, but also specify the things you don't. This is the way that communicates for us in the event we can't communicate for ourselves. That's the important part of a living will. A living will also, in turn, communicates back to your health care surrogate, that person you named. The important piece for both of these documents is to make sure you have conversations with your loved ones because if you don’t have a conversation with them and they don’t know what your wishes are, then if the situation arises and you're unable to speak for yourself, it might throw them off. They may have no idea what you want. Around all of these documents, we want to encourage that people have conversations with their loved ones, their physician, with anyone that might be involved in their care at such a time.
There is one thing that’s very important that I want to make sure I mentioned. An advanced directive such as a healthcare power of attorney, a living will or a durable power of attorney for health care is not the same thing as a regular power of attorney. A lot of people think I have a power of attorney so I'm good. No. A regular power of attorney typically does not designate a person to make health decisions not does it designate what your wishes are. Make sure that you don’t get those two things confused. You need separate documents for healthcare.
Melanie: Once we've done all of these things and set up our advanced directives and living will, where do we store them so that not only our loved ones know where they are but also if EMS comes to our house that they know what our wishes are?
Margie: A couple of things for clarification. A living will, for example, and your naming of a health care surrogate, there's a number of places you might want to put. First of all, you might want to give a copy to the person who is your healthcare surrogate. You want them to have it. You want your family members to have a copy. The thing you don't want to do with it is locked it in a box somewhere, a safe deposit box. That's really important. You may give a copy to your physician so that your physician has it. If you're ever admitted to a hospital, take your documents with you. They usually can scan them into the medical record and that way the hospital, for example, would have a document for you. The key is making sure that several people have it, make extra copies and don't put it somewhere that nobody is going to look or that it’s going to be difficult to find. Those are the key points.
Melanie: Tell us a little bit about where the physician comes in and there's something called POLST, which people may have heard about as well as that Physical Order for Life-Sustaining Treatment. What's the difference with that and how is that physician involved?
Margie: In the state of Florida, we do not have POLST. We do however have a document called a DNRO, a do not resuscitate order, and this document is specific to being out of the hospital. This is that document which you just alluded to that you would want to have posted on your refrigerator that EMS would come in and see it and now that you don't want to have life-sustaining treatment. It is a physician order so it's a document that you can have signed by your physician, it has to be signed by your physician, that’s the only person that can implement this order. In Florida, it’s always copied on a bright yellow piece of paper, we call it yellow DNRO. Let's say a person has a condition that they know they don’t want to have CPR done. It wouldn’t be recommended, it might cause harm than it would help, so they have a yellow DNRO and so that’s important for them to keep that somewhere in their home, and the recommendation is on the refrigerator because that’s where EMS is going to look first.
Melanie: What a good point to make. As far as making it official, starting that discussion, as you wrap this up for us and give us your best advice about advanced directives and making it official, getting this started because it’s so important, sometimes nobody wants to discuss it. Help us to begin that discussion.
Margie: First of all, remember, you want your choices for care to be known. You don’t want to be in a situation where you have an issue and nobody knows what your wishes are. Begin to talk with your family about it. Sometimes people will say I don’t want to talk about that, why are you bringing that up. We need to bring it up and we need to begin the conversation. The time to have that conversation is not when we’re sick. Have it now. I'm young, I'm healthy, but you know what? Something could happen, and if it does, I thought through this and this is what I would like to and this is what I would not like because that makes it so much easier for me to communicate it to others and also for my family to hear this is what she or he wants and you're never too young to have either one of these documents. Remember, anything could happen where you lose consciousness. Anything could happen to anyone where you at a given moment in time you can't speak for yourself. Pick the person you want to make decisions for you rather than be subject to having a person who’s designated by proxy. It’s always better to name someone and talk with them about it.
Melanie: It’s great advice and so important for people to hear. Thank you so much for being with us today. You're listening to Baycare Health chat. For more information, please visit baycare.org. That’s baycare.org. This is Melanie Cole. Thanks so much for listening.
Understanding Advance Directives
Melanie Cole: Who would speak for you if you become unable to communicate your own health care wishes? What kind of medical care would you want if you were too ill or hurt to express your wishes? Healthcare planning is important for everyone regardless of your age or medical condition. My guest to tell us how to go about that today is Margie Atkinson. She's the director of pastoral care, ethics and palliative care at Morton Plant Meese Healthcare, part of Baycare Health System. Tell us first what is advanced care planning and explain a little bit about the different types and why it’s so important.
Margie Atkinson, DMin, BCCol: Advanced care planning refers to a number of different documents that represent a person’s healthcare wishes largely in the event that they are unable to speak for themselves. The CDC estimates about 70% of Americans don’t have an advanced directive, so the term advance care planning represents the process, the term advanced directive represents the type of document or the type of advanced directive that you have. There are two key types of advanced directives that we see as extremely important for anyone no matter what their age. The first is called a health care surrogate or it may be called a durable power of attorney for healthcare. Both of those documents involve me naming the person that we would like to make decisions for on our behalf if we were unable to make a decision for ourselves. It only goes into effect when I can't make my own decisions, but people don’t often realize there could be many different reasons that could happen. I want to name somebody A that knows me well, that understands my wishes in the event I can't speak, so that means we need to have conversations. I want to name someone, let them know what my wishes are, and make sure I have a good conversation with them so in the event that there tasked with making a decision, they know what I want. That person’s job is to make decisions that I would want, not what they want for me.
The second type of advanced directive that's also important is called a living will. A living will is a document that a person develops that only goes into effect in the event that I'm unable to make decisions and speak for myself. A living will is different from a health care surrogate. This document lets my caregivers and my family and anyone else who might have a need to know what my wishes are in the event that I have a terminal end-stage condition or in a persistent vegetative state. Terminal usually means that it’s a condition from illness or injury from which there's no chance of meaningful recovery. What people state in a living will might be, for example, I don’t want CPR if I have this terminal condition, I don’t want to have a tube down my throat or I don’t want a feeding tube if I'm in a terminal condition. What that means is that I may be expected to die soon. Those are some of the things that a person might put in their living will.
The neat thing about a living will too is that you can specify if there's something you do want to have, but also specify the things you don't. This is the way that communicates for us in the event we can't communicate for ourselves. That's the important part of a living will. A living will also, in turn, communicates back to your health care surrogate, that person you named. The important piece for both of these documents is to make sure you have conversations with your loved ones because if you don’t have a conversation with them and they don’t know what your wishes are, then if the situation arises and you're unable to speak for yourself, it might throw them off. They may have no idea what you want. Around all of these documents, we want to encourage that people have conversations with their loved ones, their physician, with anyone that might be involved in their care at such a time.
There is one thing that’s very important that I want to make sure I mentioned. An advanced directive such as a healthcare power of attorney, a living will or a durable power of attorney for health care is not the same thing as a regular power of attorney. A lot of people think I have a power of attorney so I'm good. No. A regular power of attorney typically does not designate a person to make health decisions not does it designate what your wishes are. Make sure that you don’t get those two things confused. You need separate documents for healthcare.
Melanie: Once we've done all of these things and set up our advanced directives and living will, where do we store them so that not only our loved ones know where they are but also if EMS comes to our house that they know what our wishes are?
Margie: A couple of things for clarification. A living will, for example, and your naming of a health care surrogate, there's a number of places you might want to put. First of all, you might want to give a copy to the person who is your healthcare surrogate. You want them to have it. You want your family members to have a copy. The thing you don't want to do with it is locked it in a box somewhere, a safe deposit box. That's really important. You may give a copy to your physician so that your physician has it. If you're ever admitted to a hospital, take your documents with you. They usually can scan them into the medical record and that way the hospital, for example, would have a document for you. The key is making sure that several people have it, make extra copies and don't put it somewhere that nobody is going to look or that it’s going to be difficult to find. Those are the key points.
Melanie: Tell us a little bit about where the physician comes in and there's something called POLST, which people may have heard about as well as that Physical Order for Life-Sustaining Treatment. What's the difference with that and how is that physician involved?
Margie: In the state of Florida, we do not have POLST. We do however have a document called a DNRO, a do not resuscitate order, and this document is specific to being out of the hospital. This is that document which you just alluded to that you would want to have posted on your refrigerator that EMS would come in and see it and now that you don't want to have life-sustaining treatment. It is a physician order so it's a document that you can have signed by your physician, it has to be signed by your physician, that’s the only person that can implement this order. In Florida, it’s always copied on a bright yellow piece of paper, we call it yellow DNRO. Let's say a person has a condition that they know they don’t want to have CPR done. It wouldn’t be recommended, it might cause harm than it would help, so they have a yellow DNRO and so that’s important for them to keep that somewhere in their home, and the recommendation is on the refrigerator because that’s where EMS is going to look first.
Melanie: What a good point to make. As far as making it official, starting that discussion, as you wrap this up for us and give us your best advice about advanced directives and making it official, getting this started because it’s so important, sometimes nobody wants to discuss it. Help us to begin that discussion.
Margie: First of all, remember, you want your choices for care to be known. You don’t want to be in a situation where you have an issue and nobody knows what your wishes are. Begin to talk with your family about it. Sometimes people will say I don’t want to talk about that, why are you bringing that up. We need to bring it up and we need to begin the conversation. The time to have that conversation is not when we’re sick. Have it now. I'm young, I'm healthy, but you know what? Something could happen, and if it does, I thought through this and this is what I would like to and this is what I would not like because that makes it so much easier for me to communicate it to others and also for my family to hear this is what she or he wants and you're never too young to have either one of these documents. Remember, anything could happen where you lose consciousness. Anything could happen to anyone where you at a given moment in time you can't speak for yourself. Pick the person you want to make decisions for you rather than be subject to having a person who’s designated by proxy. It’s always better to name someone and talk with them about it.
Melanie: It’s great advice and so important for people to hear. Thank you so much for being with us today. You're listening to Baycare Health chat. For more information, please visit baycare.org. That’s baycare.org. This is Melanie Cole. Thanks so much for listening.