Pub. 3 2019 Issue 2

D o you have a living will? Medical professionals ask this question each time you go to a hos- pital for any reason. But the answer is usually “No.” Most physicians do not know what their patient’s wishes are or who the patient has designated as their medical power of attorney (POA). Start- ing the conversation about being mortal is not something physicians have been trained to do. We are trained to treat, cure, and avoid talking about the reality of our mortality. Only 1/3 of adults in the U.S. have an Advance Directive (AD) or living will, and only 7% have had an end-of-life con- versation with their doctor. Advance care planning (ACP) is the process of making deci- sions about the care of an individual based on personal values and preferences. The purpose of ACP is to docu- ment a patient’s values, beliefs, and desires for end-of-life (EOL) care. ACP allows an individual to maintain autonomy in medical decision-making when incapacitated by disease or terminal illness. The Utah Advance Health Care Directive is the legal document that was approved by the Utah State legislature in 2009. It is a four-page form that is available in most hospitals or from the internet. Utah’s form only needs a signature of a witness to make it a legal document that can be scanned into the Electronic Medical Record (EMR). If the AD is locked away in a safe deposit box, it is not very accessible in case of an emergency. Having these wishes in a person’s medical record can give guidance for the medical team when patients are unable to speak for themselves. Critical medical decisions are left to fam- ily members who may not agree on what is best for the patient. When treatment options are no longer helping the patient, decisions to stop treatment near the end of life can create disputes and ethical dilemmas. EOL studies repeatedly show that patients have prefer- ences for care in the face of death and dying. A report by the Institute of Medicine on “Dying in America” revealed that many Americans have preferences for care that improve the quality of life; however, most Americans are not fully aware of existing hospice or palliative care options. Many benefits exist when patients use ADs. Adults with ADs are more likely to choose the comfort of their homes rather than an acute care hospital setting as the place of their death. Further- more, ACP has demonstrated concordance between a pa- tient’s wishes and their EOL care, as well as increased quality By Camille Collett, M.D., MPH Advance Care Planning: Starting the Conversation About Being Mortal www.UtahAFP.org | 32