Advance Care Plans

Advance Care Plans.  We used to call them “living wills”. They were never very popular but things change and now they are big news in the medical arena.  We are now proactively engaging patients in a discussion about what their preferences would be if they were incapacitated or approaching end of life.

In fact, if you go to www.advancecareplanning.org.nz you’ll find a whole website devoted to the hows and whys of this process.  Most doctors are still feeling their way with ACP’s though we’ve been doing them regularly with patients who are terminally ill.  The general feeling is that we should be talking about this kind of thing with everybody who has a chronic life-threatening disease.  What’s the point? This quote from the website sums it up:

“Advance care planning gives everyone a chance to say what’s important to them. It helps people understand what the future might hold and to say what treatment they would and would not want. It helps people, their families and their healthcare teams plan for future and end of life care.

This makes it much easier for families and healthcare providers to know what the person would want – particularly if they can no longer speak for themselves.”

So, don’t be alarmed if your doctor begins a conversation about an ACP.  It doesn’t mean that you are about to pop off, just that we want to give you the opportunity to say what’s important to you while you can.  It always impresses me when people think ahead, even if it means addressing an unwelcome scenario.

One of my patients had a “death box”. He was not a morbid person at all, just a well-organised and realistic one, and when the time came everybody knew what he wanted.

On the same theme, it is important for older people to appoint an enduring power of attorney.  Generally you have one for financial and property matters and another one for personal care and welfare (though they can be the same person). Your EPOA makes decisions on your behalf if you are incapacitated, so they should be somebody who knows what you would have wanted in the circumstances. It’s easy to appoint an EPOA through Public Trust or your lawyer, but activating it is a bit more complicated and requires a medical certificate of incapacity, which is not a trivial medical decision.

So, borrowing the old scout motto,  “Be Prepared”!