Advance Directives & Care Planning
Advance planning provides peace of mind for you and your loved ones
Advance Care Planning at BIDMC
At Beth Israel Deaconess Medical Center (BIDMC), we want to provide care that's right for you at every stage of your life, from birth to death and at many points in between. Advance care panning helps you clarify and express your wishes. To help us do this, BIDMC’s Office of Patient Relations is working on becoming “Conversation Ready.”
We are one of ten national pioneers working with the Institute for Healthcare Improvement to enhance how we — and health systems across the country — provide care when people are very sick or near the end of their lives.
What do we strive to do?
- Reach out to our patients about what matters most to them regarding end-of-life care.
- Record those wishes and preferences in the medical record.
- Retrieve that information from the medical record if/when it’s needed.
- Respect our patients’ wishes and preferences.
Advance Directives
An advance directive is a document that tells your loved ones and health care providers what kind of medical care you want if you're too sick to speak for yourself. You can communicate in advance what kinds of care or treatments you do or do not want. Examples of advance directives:
- Health care proxy–someone you name to speak for you about your health care if you become unable to make or express decisions yourself. Your health care proxy speaks for you only on health care matters.
- Living will–document in which you outline what you would or would not want in certain medical circumstances. It can be helpful as evidence of your preferences, but it cannot cover every situation or question that might arise about your care. That is why having a health care proxy is important.
- Durable power of attorney–someone you name to act on your behalf regarding financial, legal and other matters. (Note: outside of Massachusetts, the health care proxy is sometimes called the "durable power of attorney for health care." This is not the same as a durable power of attorney.)
- Medical Orders for Life Sustaining Treatment (MOLST) form–voluntary form for patients with serious advanced illness. This form can be completed only after a conversation with a health care provider to discuss the patient's end-of-life wishes, so that the form ensures the patient receives all of the treatments that make sense for him or her and none of the ones that don't. Examples of life-sustaining treatment are CPR and breathing machines. To learn more, visit www.molst-ma.org or speak with your health care team.
How to Plan
There are several things that you can do to help make sure that your family, friends and health care team understand your care wishes.
This may be the most important step that you can take to ensure that you are cared for the way that you want. By choosing a health care proxy and completing an official proxy form, you are selecting someone to be your voice if you are unable to make or express health care decisions for yourself.
Learn more about selecting and communicating your health care proxy.
Talk with Your Proxy (and Other Loved Ones) About What Matters to You
Once you have completed a proxy form, be sure to give a copy of it to your proxy. Also, be sure to talk with this person — and other family and friends — about what you would or would not want to have happen were you to get very sick.
For your proxy to be your voice, they need to understand your wishes and worries. It may not be easy to have these conversations, but they are very important and there are many resources to help you. The Conversation Project’s Conversation Starter Kit can help you get started, and you can also ask your health care team for help.
In order for your health care providers to understand your wishes, communication is very important. Some health care providers will start the conversation with you, and others may wait for you to bring it up. Either way, it's important that you talk about this.
Also, we encourage you to ask your health care providers to include notes from your conversations in your medical record. That way, other BIDMC and affiliated health care providers can retrieve this information, if necessary, in the future.
Make sure that your primary care physician (PCP) and any specialists you see regularly have a copy of your health care proxy form. You should feel free to ask them to include your proxy information — and, if possible, the form itself — in your electronic medical record.
Planning for the future can be challenging, but there are many helpful resources.
The Conversation Project: This website offers a Conversation Starter Kit to help you plan a discussion with your health care proxy, family and/or friends. It also offers a guide to speaking with your health care provider about your wishes. Both kits are available in English, Spanish, French and Mandarin.
End of Life: This section of the National Institutes of Health website offers resources and videos about key questions related to advance care planning, such as the different types of care available at the end of life.
Death Over Dinner: This website walks you through the steps involved in planning a dinnertime conversation about dying, with a bit of humor. Like The Conversation Project, the site also offers a practical checklist to help you plan the discussion with loved ones.
