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What is advance care planning? ACP explained & defined

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Advance care planning, also referred to as ACP, is an important part of end-of-life planning. It specifically looks at your medical care at the end of your life. If it’s not something you’ve considered yet, it’s worth looking into ACP. Researching your options, making decisions, and putting plans in place now can help give you peace of mind. It also makes it easier for your family to follow through with your wishes when the time comes. Below you’ll find more information on what advance care planning is, how to start your planning, and questions you might want to ask yourself.

What is advance care planning?

Advance care planning is making preparations for medical care at the end of your life. It involves researching your options, thinking about what decisions you need to make, and leaving instructions about your wishes. ACP is important whatever age you are. It ensures you’ll be cared for in the way you prefer, even if you become unable to make or voice those decisions yourself.

Advance care planning vs. advance directive

You might have heard of advance directives. Advance directives are part of advance care planning. A common type of advance directive (also sometimes called a healthcare directive) often combines two documents: the healthcare power of attorney, and the living will. A living will is a legal document that states your wishes regarding medical treatments and decisions. A healthcare power of attorney grants authority to someone you’ve chosen to act on your behalf when it comes to your health. In one single document, you can both designate who you want making decisions for you if you are unable to do so, and give instructions on what types of healthcare treatment options you want or don’t want.

The advance care planning process

Advance care planning can seem daunting, but it can be split into a few stages. This can make it feel more manageable.

1. Think about your wishes

You might have never thought about your end-of-life care before and not know where to start. Read about what’s involved in advance care planning, review samples online, and ask yourself what types of medical care you’d feel comfortable receiving. In the section below, you can find some helpful questions to help you get started.

2. Talk with loved ones

Often, difficult decisions are made easier by talking them through. If there’s someone in your life you feel comfortable discussing advance care planning with, then they can help you mull over your options. Also, your family may be the ones who are with you when your advance care plan needs to be implemented, so it can be good to include them in the planning process from the start. Clear communication now can help avoid difficulties later if your family has to make the decisions because you are no longer able to do so.

3. Designate who you want to make decisions on your behalf

Often, people choose their spouse or an adult child to be their healthcare agent — the person entrusted with healthcare decision-making should you not be able to make decisions for yourself. In many cases, this is the best choice. But it is always good to think beyond your first impulse, as sometimes other people — a trusted friend, or more distant relative — may have a personality better suited for having in-depth conversations with doctors and making really difficult decisions.

4. Make choices about your care

Once you’ve gathered information and had time to think, you should be in a place to start making decisions. Typically, you should decide which, if any, life-sustaining treatments you would want, such as cardio-pulmonary resuscitation (CPR), use of a breathing machine, and admittance to an intensive care unit. It’s also helpful to share your thoughts on other treatments like dialysis, tube feedings, and pain management. Since it’s impossible to predict every choice that will need to be made, it is best that your agent understand your overall goals for healthcare so he or she feels confident in making any decision that comes up.

5. Record your wishes in an advance directive

To make sure your wishes are carried out, have them recorded in an advance directive. A properly documented and witnessed advance directive becomes a legal guideline that healthcare professionals are bound to follow. Be sure to give copies of the finalized directive to your doctor’s office, your agent, and others who will likely be involved in your care. Do not place the directive in a safety deposit box or with your attorney for safekeeping — it needs to be readily accessible when it is needed. 

6. Review your ACP regularly

Throughout your life, things change. For example, you might develop a new condition that affects your wishes for end-of-life care. Your relationships may also change, and you might want to change your healthcare agent (in some states, called a proxy). Therefore, you should review your advance care plan on a regular basis, particularly if anything changes.

Questions to ask yourself when planning your care

These questions will help you with the first stage of the advance care planning process — thinking about what your wishes for end-of-life care might look like.

1. Which tests, treatments, and medications do you want to receive as you near the end of your life?

Different medical interventions have different benefits and side effects. Learning about the treatments you might need toward the end of your life can help you make an informed decision. Treatments to consider include CPR, intubation, ventilation, blood transfusions, use of dialysis machines, use of artificial nutrition and hydration, and use of antibiotics or antiviral medications. Make sure you specify what treatments you do not want, especially if they go against your faith tradition, so doctors and hospitals have guidance on what is appropriate for you.

2. Which types of care do you not want to receive?

For example, if you are very ill, you might prefer not to have invasive treatments and instead receive palliative care — care to keep you comfortable and to lessen the side effects of your underlying illness, as opposed to care attempting to cure your illness — to improve the quality of the life you have left. Another option is to say you are interested in a trial period of a treatment, but if there is no improvement to your health status in a predetermined amount of time, you want it stopped.

3. Where would you like to spend your final days?

You might want to remain in a healthcare facility so that healthcare professionals are always on hand. Or you might prefer to spend your final days at home in a familiar environment, receiving care from home care and hospice professionals. This will have an impact on the medical care you receive. Note that most advance directive forms do not include questions about what you would like to happen with your body following death, but you are more than welcome to add your preferences to the document. Usually, your agent does not have the legal authority to make decisions once your life has ended, unless you specifically give them that power in your directive or elsewhere in your estate planning documents.

4. Who will advocate for you if you’re ill or incapacitated?

Your healthcare agent needs to be someone you trust, who understands your wishes and what’s important to you. This person should agree to take on this responsibility and does not have to be a relative. You should also consider the geographical location of this person — it might be easier to choose someone who lives close by.

Planning for the “what-ifs”

Advance care planning is about preparing for a range of scenarios to make them easier to navigate if and when the time comes. These are extremely personal decisions, and taking the time to think and plan in advance can ease the strain on you and your loved ones if you do become ill. If you’d like help with other aspects of end-of-life planning, see our end-of-life planning checklist and tips for organizing your end-of-life documents. You can also ask your healthcare provider for assistance.

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