National Healthcare Decisions Day is April 16 and this year, it comes at a time when healthcare (and our decisions surrounding treatment) are at the forefront of our minds. In a year where a global pandemic has brought the world to a halt, many people may be looking for answers to that difficult question – how do I want the end of my life to look?
These decisions are always tricky, but that does not make them any less important. We walk through the basics of advance care planning, along with what you should look out for in light of the past few years, below.
What is National Healthcare Decisions Day?
National Healthcare Decisions Day has been held on April 16 for the past 12 years, according to the National Hospice and Palliative Care Organization (NHPCO). It makes sense – the day after income taxes are due is always a good time to get your affairs in order, and it’s important to make those crucial healthcare decisions sooner rather than later. NHPCO President and CEO Edo Banach has said: “far too many Americans put off talking about their health care wishes and then they find themselves in a medical crisis and it may be too late to ensure that you get the care you want.”
Advance care planning is threefold – it involves learning about the types of decisions to consider, thinking about your preferences ahead of time, and then communicating those preferences to the people in your life. Typically, those decisions go into a legal document called an advance directive, which, according to the National Institute on Aging (NIA), only goes into effect if you are incapacitated or otherwise cannot communicate for yourself.
When considering your healthcare decisions, there are specific elements to consider. Below is an overview of some of the most important things to consider when it comes to healthcare below.
Health insurance is a significant factor when it comes to discussing your healthcare decisions. It’s crucial to think about how you (and your family) will fund any illnesses or other health needs.
Health insurance rates vary by state, so research is essential. The Biden Administration has kept the Affordable Care Act (ACA) marketplace open for an extended period in 2021; however, enrollment times and effective dates vary by state. HealthMarkets has summarized this information according to state in a useful, easy to read manner to make it easier for consumers to understand their options.
The most common discussions regarding end-of-life care are decisions about the procedures designed to keep you alive, artificially or mechanically. According to the NIA, these include:
- Cardiopulmonary resuscitation (CPR): this type of treatment restores your heartbeat if your heart stops or is beating irregularly. It can result in a collapsed lung or a broken rib, and paramedics could also administer an electric shock via a defibrillator.
- Ventilators: ventilators help patients breathe when they cannot breathe on their own.
- Nutrition and hydration: the subject of artificial nutrition and hydration is a common discussion to have when the person in question cannot feed themselves. However, the NIA suggests that artificial nutrition does not meaningfully prolong life when used at the end of life.
- Comfort care: these are the measures that doctors will take to keep you comfortable as you approach the end of life. Comfort care includes managing any shortness of breath, limiting all medical tests, providing counseling, and giving medication for pain, anxiety, nausea, and constipation.
Of course, these are significant factors to consider. The NIA suggests thinking about these decisions and having a separate discussion with your doctor about the probability of developing diseases and any risk factors you have of developing these or similar issues. The NIA also suggests considering your values and asking yourself questions such as:
- Is your main desire to have the most days of life, or is quality most important?
- What would you want if an illness left you paralyzed and you needed to be on a ventilator?
- What makes life meaningful to you?
- Would you be content if you could only spend your day listening to books on tape or looking out the window if an emergency left you paralyzed?
These are hard questions to answer but essential when it comes to considering healthcare decisions.
After considering health insurance and care, it’s time to write these decisions down in an official document known as an advance directive. The experts at Death with Dignity define an advance care directive as a document that:
- Articulates and documents your wishes about medical treatment if you lose decision-making ability; and/or
- Designates an individual that ensures your wishes are honored if you cannot communicate them.
You should also include the following in an advance directive:
- The name and contact information of your healthcare proxy.
- The answers to the specific questions and preferences you’ve discussed above if you cannot speak for yourself. Downloadable forms are available that differ slightly for each state.
- The names and signatures of the individuals who have witnessed the signature of your advance directive (this varies according to state).
- The signature and seal of a notary, if required by state.
National Healthcare Decisions Day is an important reminder to think about these difficult but crucial life decisions. It’s valuable to have a plan and to consider the future before it happens.