Ask the Expert: Unexpected Injury or Illness — Do You Have a Plan?

John Tastad

If you or someone you love faces a catastrophic health situation or illness, having a plan in place can help guide health care decisions that must be made on behalf of the individual who is unable to do so on his or her own. John Tastad, a coordinator of the Advance Care Planning Program and a spiritual care counselor at Sharp HospiceCare, answers questions about advance care planning and how it can be a valuable tool for any individual and his or her family.

Why is it important to plan for a health care emergency?
Every adult should embark upon the advance care planning journey. Advance care planning is the process of health care decision making that expresses your preferences should an emergency situation occur or a serious illness progress. 

Communicating your preferences ahead of time can decrease the chance of future conflict and ease the burden from family members who may need to make health care decisions on your behalf.

How does an advance care plan help address health care emergencies or other challenging health situations?
In an emergency or other challenging health situation, sometimes important medical decisions must be made — decisions related to starting or continuing artificial respiration, nutrition or hydration, for example. Advance care planning involves the completion of an advance directive, which documents and reflects these types of preferences.

Often medical staff turn to family members of a patient if he or she is not physically able to communicate preferences regarding proposed interventions. Without an advance care plan, those family members wonder, "What would our loved one want us to do?" Advance care planning helps to take the guesswork away, as values, beliefs and preferences for treatment or care have been considered and expressed in a written advance directive.

When should I have an advance care plan in place, and who should be involved?
It is best to consider your options as early as possible, while you have time to think through them clearly and then discuss your preferences with your family, health care providers and those close to you. The advance care planning process allows you to:

• Appoint a qualified, informed health care agent who can carry out your wishes based on understanding and respecting your values and beliefs about treatment and care
• Articulate your preferences clearly in a written advance directive
• Assess your values, personal concerns, spiritual beliefs and other important issues
• Create dialogue to discuss your own preferences and ideas with other friends or family members

What are the risks of not having an advance care plan?
Regarding health care decision making, no decision is a decision. If you don't make advance health care decisions or appoint someone to make health care decisions for you, the medical team providing treatment and care will not know what your preferences are. 

If you are in an emergency situation and your preferences have not been expressed, you will receive full, aggressive treatment for cure. Many people want that type of treatment, particularly when they are younger and do not have complicated medical concerns. The preference for aggressive treatment for cure can be indicated in an advance directive. 

Some people — particularly older patients with complicated, serious medical conditions — understand that aggressive treatment efforts might be contraindicated and might prolong their suffering before they die. The preference to forego aggressive treatment and opt for aggressive palliative or comfort measures can also be indicated in an advance directive.

What if I decide to make changes to my plan?
It is important to remember that an advance directive can be changed at any time. Advance planning for health care is always a work in progress. That's because circumstances change, and lives change. A person's values and priorities even change. It is important to reexamine health care preferences whenever any of the "Five D's" occur:

• Death — whenever you experience the death of a loved one
• Decade — when you start each new decade of your life
• Decline — when you experience a significant decline or deterioration of an existing health condition
• Diagnosis — when you are diagnosed with a new or serious medical condition
• Divorce — when you experience a divorce or other major family change

If your preferences change, complete a new advance directive. If you change your advance directive, it is important to notify everyone who has copies of your old advance directive form. If there is ever any confusion regarding which advance directive should be honored, the most recently dated form available will be adhered to. 

Is there a fee for having an advance care plan?
Advance care planning support is available free of charge through the Advance Care Planning Program at Sharp HospiceCare. Some community agencies are also available to provide advance care planning support, and online assistance is available as well.

There is no fee to obtain and complete an advance directive. Visit Advance Care Directive for more information and to download a copy of the California Advance Health Care Directive form.

Some people prefer to consult with a legal advisor regarding their health care preference and advance directive, for which there is a fee.

What is the first step in developing an advance care plan?
The first step in advance care planning is to recognize its importance. You can contact Sharp HospiceCare's advance care planning program at 619-667-1900, which provides education, resources and support.

For More Information
To learn more about Sharp HospiceCare, call 619-667-1900. To find a Sharp-affiliated physician, search for San Diego doctors or call 1-800-82-SHARP (1-800-827-4277), Monday through Friday, 8 am to 6 pm. To find general information about hospice care, read the Home Care and Hospice News archive.