Advance Care Planning

Choice is an increasingly important part of health care policy, especially at the end of life as deteriorating mental and physical functions may lead to a situation where a person no longer can express his or her preferences. The goal of an advance care planning discussion is to ensure that clinical care is consistent with the person's expressed preferences and wishes. This planning process also may reduce the incidence of anxiety, depression and post-traumatic stress in surviving relatives and may improve resident and family satisfaction with care.

By educating residents, families or surrogate about advance care planning, they can make a more informed decision about current or future medical care. This process may prevent unwanted medical interventions, particularly near the end of life.

Advance care planning includes making decisions about the use of life-sustaining measures – such as CPR, artificial ventilation, and artificially administered nutrition and hydration – as well as the risks and benefits of these measures. The process also may address additional medical interventions, such as hospitalization, chemotherapy, dialysis or antibiotic therapy that might eventually be considered. Decisions should be recorded in specific documents to ensure that the person's decisions will have the support of the law. In Texas, these documents include

Brief, periodic discussions may be more useful than a one-time discussion about advance directives. The directive to physicians, family or surrogates establishes a framework to discuss current quality of life and what level of medical treatment will be provided at the end of life. The medical power of attorney allows a resident to designate a person to speak for him or her; the resident's agent is then able to make all health care decisions for the resident once he or she has been certified as incompetent by a physician.

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