Medical

Advance directives

An advance directive tells your doctor what kind of care you want if you are unable to make medical decisions. Advance directives can include living wills and health care proxies.

  • Living Will — describes the kind of medical or life-sustaining treatments you want if you are seriously or terminally ill.  While it is not considered a legal document by New York State code, use of living wills to share your wishes is well-established in the state. There is no standard template for living wills. You can find several examples online, get a form from your doctor, health department or state department on aging, or work with your lawyer. Here are two examples available online:
    • CaringInfo – provides links to state specific Advance Directive forms. For New York State, the form includes both the Health Care Proxy form and a living will.
    • Five Wishes — considered one of the more comprehensive living will templates. Written in everyday language, it speaks to your medical, personal, emotional and spiritual needs. The way it is presented can help structure discussions with your family and physician.
  • Durable Power of Attorney for Health Care (also known as a health care proxy or agent) — used to identify the person(s) you trust to make your health care decisions if you lose the ability to do so (including temporary loss of capacity).  Everyone age 18 or older should have a Health Care Proxy.
    • Be sure to select someone who will follow your wishes and can advocate for you in a health care setting.
    • The form does not require a notary or an attorney to be valid, only the signature of two adult witnesses who have not been named as your proxy or your alternate proxy.

By creating your advance directives before you are faced with an illness or injury, you can spare your loved ones the stress of making decisions about your care if you are unable to do so. Make sure you share your documents with your loved ones, your doctor and your local hospital.

Review these materials periodically to ensure they are current and they still reflect your preferences.

Take a few minutes to listen to one person’s version of their wishes for treatment…

Read the poem

Other considerations

  • The Compassion & Choices site has some useful forms to supplement your advance directives, including a Dementia Provision.
  • End of Life Choices New York has developed an advance directive for those with an early stage of dementia. It is designed to permit those who retain decision making capacity to document their wishes about the future provision of assisted oral feeding in the event they develop an advanced stage of dementia and can no longer feed themselves or make informed treatment decisions. It might also be of interest to those who have not yet been diagnosed with dementia but fear a future diagnosis due to a significant family history of the disease.
  • Advance directives are not necessarily transferable between states, so if you spend time in multiple states, be sure you have the correct paperwork for each of them.

Medical orders

A Do Not Resuscitate Order (DNR) is a medical order not to have cardiopulmonary resuscitation (CPR) if your heart stops or if you stop breathing.  If you’re not confident that you understand the reality of CPR versus what we see on TV, please take a few minutes to read through “What Doctors Know About CPR.”

Two other types of medical orders include a DNH (Do Not Hospitalize) and a DNI (Do Not Intubate).

The MOLST or POLST form (Medical—or Physician’s—Orders for Life Sustaining Treatment) is a medical order that tells others a person’s wishes about CPR and other life-sustaining efforts. It is intended for persons with serious health issues. While you can discuss the details on a MOLST form with many types of health care staff, it must be reviewed and signed by a doctor.

Palliative care

Palliative care is specialized medical care for people with serious illness. This type of care is focused on providing relief from the symptoms and stress of a serious illness. The goal is to improve quality of life for both the patient and the family.

Palliative care is provided by a specially-trained team of doctors, nurses and other specialists who work together with a patient’s other doctors to provide an extra layer of support. It is appropriate at any age and at any stage in a serious illness, and it can be provided along with curative treatment.”

[from getpalliativecare.org]

Hospice

Hospice is both a philosophy and an approach to caring for the terminally ill that provides physical, emotional and spiritual comfort.  An interdisciplinary team* responds to the needs of the patient and their families. Such care may take place at home, in a hospital, nursing home or a hospice residence.

Hospice services are available to patients of any age, religion, race, or illness. Hospice is not only for people with cancer. About 60% of hospice patients do not have cancer, but other life-limiting conditions such as heart disease, lung diseases, dementia, HIV/AIDS, or debility (old age).

Hospice care is covered under Medicare, Medicaid, most private insurance plans, HMOs, and other managed care organizations.

*A hospice team usually includes:

  • the patient’ s personal physician;
  • hospice physician (or medical director);
  • nurses;
  • home health aides;
  • social workers;
  • clergy or other counselors
  • trained volunteers; and
  • speech, physical, and occupational therapists, if needed.

The hospice team:

  • manages the patient’s pain and symptoms;
  • assists the patient with the emotional and psychosocial and spiritual aspects of dying;
  • provides needed drugs, medical supplies, and equipment;
  • coaches the family on how to care for the patient;
  • delivers special services like speech and physical therapy when needed;
  • makes short-term inpatient care available when pain or symptoms become too difficult to manage at home, or the caregiver needs respite time; and
  • provides bereavement care and counseling to surviving family and friends.