Written by James Coleman
The NCIOM is convening a Task Force on Serious Illness Care. With funding support from the Duke Endowment, the Task Force is bringing together more than 60 serious illness care stakeholders to develop a workable plan to meet the needs of individuals living with serious illnesses and their caregivers across North Carolina. One of the areas the Task Force will examine during the next few months is Advance Care Planning (ACP).
What is Advance Care Planning?
ACP is the process of planning ahead for what course of action should be taken if one has a life-threatening medical emergency or terminal illness, and is unable to communicate one’s care wishes.1 Having a care plan in place helps ensure that a person’s wishes are known (and hopefully respected), and it takes the decision-making burden off of loved ones.
During the ACP process, individuals can make their wishes known in writing using ACP documents that fall into two categories: Advance Health Care Directives and Medical Orders.2 Advance Health Care Directives are legal documents that ensure patients’ health care wishes are known when they have a terminal illness, are in a vegetative state, or are having a mental health crisis. In North Carolina, these documents include Advance Directives for Natural Death (also known as a living will), Advance Instruction for Mental Health Treatment, and Health Care Power of Attorney. A living will allows a patient to plan for what measures, if any, should be taken to prolong their life if they have a terminal illness or are in a vegetative state.3
An Advance Instruction for Mental Health Treatment works similarly to a living will, allowing patients to make their wishes known about their preferences in receiving or refusing mental health treatment. The Health Care Power of Attorney document empowers patients to designate someone to be their health care agent, who would have the broad power to make health care decisions for patients when they have a terminal illness and are in an unconscious state.
For the three documents to be valid, the patient, two witnesses, and a notary public must sign them. Once notarized, the documents can be filed with the NC Secretary of State Office and registered with the NC Advance Health Care Directive Registry.3
Reasons to use Advance Care Planning
Having Advance Health Care Directives is important; however, they are not applicable during medical emergencies, such as going into cardiac arrest. Patients can have Medical Orders in place to execute their wishes in cases of life-threatening medical emergencies. Medical Orders include Do Not Resuscitate (DNR) orders and Medical Orders for Scope of Treatment (MOST).1 The purpose of a DNR order is to indicate an individual’s wishes to not be resuscitated in the event of cardiac or pulmonary arrest. The MOST form allows a patient to outline a series of choices of which resuscitation or life-prolonging measures should be given in end-of-life care situations. These choices include whether to receive CPR, medical intervention, antibiotics, and artificial nutrition and hydration. If a DNR or MOST are not in place in the event of medical emergencies, the default option for medical providers will be to administer lifesaving or life-prolonging measures. A MOST form and DNR must be obtained from and signed by a physician, physician’s assistant, or nurse practitioner. They are not intended to be a replacement for Advance Directive documents.1
Throughout the course of the Serious Illness Care Task Force work, there will be an in-depth analysis of the ACP system in North Carolina.
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