Planning for End of life:Your values, your wishes, your dignity

Donna Clare RN MN Nurse Practitioner,Faculty, Athabasca University

February 2014

Objectives

We will discuss:

•Why planning is important•What you need to consider•How to plan for end of life care decisions•Who to include in the discussion and how

Planning for End of LifeWhy bother?

•Often there are choices to be made

•Family members often disagree

•Treatments have consequences

•Prolonging life vs prolonging dying

•Control over your own life

ChoicesTwo basic choices:

•What you want •What you don’t want

Based on: •Belief systems (life, death, purpose)•Personal values (preferences, dignity)•Character traits (coping, feelings)•Personal limits (pain, suffering, change)

What choices are there?•What is legal and illegal?

•How much (pain, loss, indignity, treatment) is okay/not

okay?

•How do I prefer to die?

•In what circumstances are tubes, machines and

resuscitation okay and not okay?

•Who will speak for me when I cannot?

Choices•Active Euthanasia is not legal in Canada

•Assisted suicide is not legal in Canada

•Allowing normal processes to proceed

without intervention is legal

•Withdrawing earlier interventions is tricky

but not illegal

Choices about life and living•How do I want to live?

•What is worth going through to continue

to live? Will it prolong my life in a

meaningful way?

•How much ________is okay/not okay?

Choices about dying•How do I want to die?

•When does prolonging life become prolonging dying? (Does this concept have any real meaning to me?)

•Where do I want to die?

Choices•In what circumstances

are tubes, machines and resuscitation

okay and not okay?

What about organ donation?

ChoicesWho will speak for me when I cannot?

Health Care ProxySubstitute Decision-makerMedical Power of AttorneyHealth Care agentDurable power of attorney for health

How can I direct them regarding my wishes?Who should know my wishes?

Planning for End of LifePower of Attorney – financial/legal

Will – written instructions about your estate and sometimes burial details.

Health Care Proxy – health care decisions

Living Will/ Advanced Directive – written instructions for catastrophic or end of life decision-making

Health Care Proxy

Should have knowledge about your wishes and the type of person you are

Should direct care the way YOU would if you could - sometimes that means someone who can make these decisions and fight for you

Should listen carefully, ask questions and consider your wishes when making decisions.

Should act in YOUR best interest.

Living Will /Advanced DirectiveIt provides guidance to family, health care

personnel and your proxy when a decision must be made. It may decrease family tensions.

Address non-medical ideas, too: what are your fears (alone, pain, losing control, abandoned,….)

A living will should ideally be made when the person is healthy and of sound mind.

And it should, ideally, be signed, dated and witnessed by 2 people

Who should have a copy of your advanced directive?•Your health care proxy•Family members•Your lawyer•Your physician or Nurse Practitioner•A health care facility

•You should name your health care proxy and an alternative in writing; in this or a separate document, signed dated and witnessed.

Some common concernsIf I, as proxy, stop or refuse treatment I will be “giving up” on them.

What will others think of me if I decide to stop aggressive treatment?

If I have a will or living will, I will bring death on.

If I have a living will, they will let me go sooner.

Does stopping treatment mean stopping care?

Dying from lack of food and fluids is painfulWhat if I make the wrong decision?

How to talk to family members•Express your feeling of helplessness

should something happen

•Express your need to honour their wishes

but you need to know what they are

•Bring up an experience and explore their

perspectives

•Small bites versus the big talk

Questions?