If you were very ill—too sick to communicate your wishes—what kind of healthcare would you want?
That’s the basic question behind an advance directive, an important legal document that everyone should have, but critical for those with life-limiting illnesses. An advance directive allows you to convey your decisions about medical care and end-of-life care to family, friends and healthcare professionals. It helps avoid confusion, which can add pain to an already emotional situation for the loved ones of the ill person.
Advance directives include:
Living will. This is a written, legal document that lays out your wishes regarding medical treatments and the life-sustaining measures you want and don’t want. These include the use of dialysis and breathing machines, your desire to be resuscitated if breathing or heartbeat stops, tube feeding, and organ or tissue donation. You can express your wishes to accept or refuse medical care in this document.
Medical or healthcare power of attorney (POA). This legal document is also written and it designates a person, known as your healthcare agent or proxy, to make medical decisions for you if you’re too sick to do so yourself. This proxy should be someone you trust who knows your wishes.
Do not resuscitate (DNR) order. A DNR takes effect if your heart stops or if you stop breathing. It is a request not to have cardiopulmonary resuscitation (CPR). DNRs are optional in advance directives.
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Serious, life-limiting illness is a time of radical and profound change for patients and their loved ones. During this transitional period, many deep questions often arise about the spiritual dimension of life, both in relationships with other people and perhaps with a power greater than themselves.
Spiritual care, from a wide range of traditions and styles, is a core service offered by hospice, and yet it is often perceived as representing the philosophies or teachings of a specific religion or sect. In fact, hospice spiritual care is much more than that.
We believe every person has a spiritual dimension, special beliefs about how the world is ordered, the meaning of living and a connection with the universe. This often takes the form of a faith that organizes and makes sense of this world giving meaning to patients’ lives. These life values play an integral part in the patient and family’s response to the life-limiting illness.
Hospice spiritual care offers to meet emotional and spiritual needs of patients at the end of life as well as the needs of their loved ones. The significance of spiritual care is different from person to person. For some people, this spirituality takes the form of organized religion; for others, it does not. Many need to make peace with certain issues in their lives or evaluate the meaning of life overall.
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As a nurse for over 30 years, I have often seen patients and families struggle in understanding the complexity of medical care prescribed to them. They often are afraid, confused and misinformed about their diseases and treatment sets. In my patients with serious illness, I often wished for a better way to coordinate all the professionals working for their health.
It has been my pleasure and privilege to play an active role in the development of a different holistic program over the last ten years, something we call palliative care. As part of the next step in this growth, we’re introducing AseraCare Palliative Medicine across the United States this year and in 2012.
Our palliative medicine team approach coordinates all the players in a patient’s well being: physicians, nurses, nutritionists, pharmacists, physical therapists, occupational therapists, speech therapists, social workers, chaplains and volunteers. They have the time to spend with you to discuss treatments, goals and concerns. They will offer information about home health, hospice or community resources for care needed as goals and treatment plans are established. They in effect “bridge” treatment plans between service providers.
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As the Director of Psychosocial Services for AseraCare Hospice, I have a passion for spreading the news of hospice and palliative medicine. These services relieve suffering, improve quality of life, bring families closer together and help seriously ill people cope with their illnesses, and, in many cases, help patients prepare for the end of life.
Tomorrow is the perfect day to shine the light of awareness because it’s World Hospice and Palliative Care Day, when thousands of people in about 80 countries worldwide will come together at more than 1,000 events to celebrate, support and speak up about these important medical services.
The theme for this year is, “Many diseases, many lives, many voices—palliative care for non-communicable conditions.” These include illnesses such as cardiovascular diseases, cancers, chronic respiratory conditions and diabetes, diseases that cause about 60% of death worldwide.
There is a difference between these two services. Hospice is non-curative medical care for terminally ill people who generally have less than six months to live. The focus is on pain and symptom management. With palliative medicine, the patient does not have to be terminal, but has a serious, life-threatening illness, and treatment can be curative or not.
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