Advance Care Planning and Grief Resources

Advance care planning is making decisions about the healthcare you would want to receive if you become unable to speak for yourself. These are your decisions based on your personal values, preferences and discussions with your loved ones. Advance care planning provides you with a way to make your wishes regarding end-of-life care known to those who will be making decisions for you in the event that you cannot make those decisions. You do not need a lawyer to complete advance care planning.

The four steps of advance care planning:

1. Designation of Healthcare Agent
   This document allows you to designate someone else to make healthcare decisions when you cannot do so. The best time to do this is when you are in good health.
   
   
2. Living Will
   This document records your treatment preferences in certain situations, such as a terminal condition, comatose or non-responsive condition, and end-stage condition, providing guidance to family and health care providers.
   
   
3. Maryland Medical Orders For Life-Sustaining Treatment (MOLST)
   The MOLST supplements the Living Will for patients with chronic advanced or serious medical conditions. It is completed with the assistance of a physician, nurse practitioner or physician's assistant. Your MOLST form travels with you to other healthcare facilities, such as hospitals or rehabilitation centers, and needs to be verified during each hospital admission because sometimes preferences change. Preferences for life-prolonging measures indicated on the MOLST apply to a variety of circumstances and treatment options, including:
   
   • Cardiopulmonary resuscitation
   • Artificial ventilation
   • Blood transfusion
   • Hospital transfer
   • Medical workup
   • Antibiotics
   • Artificially administered fluids and nutrition
   • Dialysis
     
     
4. Communicating Your Wishes
   Discussing your medical preferences with your family and loved ones provides them with guidance to your end-of-life care. This also allows the individual to address issues that are not in the advance directive or LIVING WILL. Also, make your healthcare provider aware of your wishes. Present copies of your advance directives to your healthcare provider and local hospital. Also, keep a copy of the MOLST form on your refrigerator in case emergency medical services must be called.

Advance Directive

An Advance Directive combines the Designation of Healthcare Agent and Living Will into one document.

Advantages of Advance Care Planning

The most difficult part of advance care planning is often just raising the topic. Tools from National Healthcare Decisions Day provide guidance. Short videos are available to assist in starting the conversation with loved ones.

Advantages of completing the process in advance of an illness or emergency are as follows:

• You continue to have a say in your medical care, even if you become too sick to speak for yourself.
• You will have peace of mind, knowing that you are more likely to receive the medical treatment you would want and not receive the treatment you would not want.
• By knowing your wishes, your family and friends are relieved of the burden of having to make decisions without knowing your choices in a highly stressful situation.
• Research shows that if health care providers inform people about possible future treatments and listen to their wishes, better end-of-life care is maintained.
• Studies conducted in a range of healthcare settings suggest that advance care planning can improve individual and family satisfaction with care, reduce the number of hospitalizations in the last months of life and reduce stress, anxiety and depression in surviving relatives.

Advance Care Planning Information

• Maryland Advance Directive: Planning for Future Health Care
• Maryland Medical Orders for Life-Sustaining Treatment (MOLST) Form
• Conversations before the Crisis

Grief Resources

• MentalHealth.com – Grief and Bereavement Issues
• Family Caregiver Alliance – Grief and Loss