Advance care planning is a process of planning for future medical care in case you are unable to make your own decisions, either temporarily or permanently. It is a communication process and not merely a document. The process results in the completion of advance directives.
Advance directives are written instructions on how you want future medical decisions made in case you are unable to make medical decisions yourself. The two types of advance directives in New York are the health care proxy and the living will. In some states, the forms are combined. In other states, the equivalent of the health care proxy is known as a power of attorney for health care. Advance directives are the end result of the advance care planning process and only apply only when you are unable to make decisions about your medical care.
Antibiotics are medications used to treat infections; for example a kidney or bladder infection (urinary tract infection) or a lung infection (pneumonia).
Artificial hydration and nutrition refers to when a person can no longer drink or eat, liquid fluids or food can be given by tube.
Capacity is the ability to take in information, understand its meaning and make an informed decision using the information. Capacity varies by task. The capacity to choose a trusted individual as an appropriate Health Care Agent differs from the capacity to agree to a medical procedure or treatment.
CPR involves artificial breathing and forceful pressure on the chest to try to restart the heart. It usually involves electric shock (defibrillation) and a plastic tube down the throat into the windpipe to assist breathing (intubation). It means that all medical treatments will be done to prolong life when the heart stops or breathing stops, including being placed on a breathing machine and being transferred to the hospital.
Comfort measures are medical care and treatment provided with the primary goal of relieving pain and other symptoms and reducing suffering. Reasonable measures will be made to offer food and fluids by mouth. Medication, turning in bed, wound care and other measures will be used to relieve pain and suffering. Oxygen, suctioning and manual treatment of airway obstruction will be used as needed for comfort.
No matter what else is chosen in terms of life-sustaining treatment, the patient will be treated with dignity and respect, and health care providers will offer comfort measures
Dialysis is a treatment that helps purify the blood of toxins that build up when the kidneys are no longer working well and your own kidneys can no longer take care of your body’s needs.
Frailty is a clinically recognizable state of increased vulnerability resulting from aging-associated decline in reserve and function across multiple physiologic systems such that the ability to cope with every day or acute stressors is comprised.
A frail person has trouble performing activities of daily living because of weakness or fatigue. Frail individuals are vulnerable to acute illness due to low activity level.
The health care proxy is a legal form that gives the person you choose as your health care agent the authority to make all health care decisions for you, including the decision to remove or provide life-sustaining treatment, unless you say otherwise in this form. “Health care” means any treatment, service or procedure to diagnose or treat your physical or mental condition.
IV fluids are provided by a small plastic tube (catheter) that is inserted directly into the vein. Fluids are given through the catheter.
If a patient chooses not to have IV fluids, food and fluids are offered as tolerated using careful hand feeding.
Intubation is the process of placing a plastic tube down the throat into the windpipe to assist breathing. Intubation is followed by mechanical ventilation, which means connecting the tube to a breathing machine used to support or replace the function of the lungs.
If a patient chooses to withhold intubation and mechanical ventilation, treatments are available for symptoms of shortness of breath, such as oxygen and morphine.
The living will is an advance directive that lets you state your wishes about medical care in the event that you develop an irreversible condition that prevents you from making your own medical decisions. The living will becomes effective if you become terminally ill, permanently unconscious or minimally conscious due to brain damage and will never regain the ability to make decisions. Although not a legal New York State form, the Living Will provides the “clear and convincing evidence” needed to have your wishes carried out.
Mechanical ventilation is used to support or replace the function of the lungs. A ventilator (or respirator) is a machine attached to a tube inserted through the nose or mouth and into the windpipe that forces air in and out of the lungs. Mechanical ventilation is often used to assist a person through a short-term problem or for prolonged periods in which irreversible respiratory failure exists.
Some people on long-term mechanical ventilation are able to enjoy themselves and live a quality of life that is important for them. However, for the person who is dying, mechanical ventilation often merely prolongs the dying process until some other body system fails. It may supply oxygen but it cannot improve the underlying condition.
If a patient chooses to withhold intubation and mechanical ventilation, treatments are available for symptoms of shortness of breath, such as oxygen and morphine.
The Medical Orders for Life-Sustaining Treatment (MOLST) program is designed to improve the quality of care seriously ill people receive at the end of life. MOLST is based on the patient’s current health status, prognosis, and goals for care. The discussion emphasizes shared medical decision-making that helps the patient understand what can and cannot be accomplished. The result is a set of medical orders that must be honored by all health care professionals in all settings. MOLST is New York’s endorsed National POLST Paradigm program.
The National Physician Orders for Life Sustaining Treatment (POLST) Paradigm (NPP) is a process of communication & shared decision making that result in a set of portable medical orders for a seriously ill person who might die in the next year. Different states use different names for their NPP program. The NPP has established endorsement requirements. For information on other state NPP programs, visit POLST.org
Providing fluids and/or nutrition by way of a tube placed into the stomach or intestines. On a short-term basis, the tube (nasogastric tube or “NG-tube”) is placed into the nose, down the throat and into the stomach. For the long-term, the tube is placed directly into the stomach (gastric, or “G-tube”)
If a patient chooses not to have a feeding tube, food and fluids are offered as tolerated using careful hand feeding.
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