As people grow older, the idea of planning ahead for certain live events becomes more of a reality. And while not many people like to talk about the end of life, thoughtful discussions about it will help prevent dilemmas if the unthinkable happens.
To ensure you receive the care you want in the event of a severe or fatal injury or disease, there are documents you can accomplish to communicate your preferences. These documents are known as Advance Directives. These can also be used to identify an authorized health care proxy who can provide informed choices on your behalf.
Advance Directives
Advance directives are written instructions to your healthcare providers. These are established before the need for medical intervention. They help ensure your providers respect your autonomy when you cannot express your wishes.
In addition, it guides healthcare professionals and family members on how to proceed with life-sustaining interventions.
Advance Care Planning in the Philippines
The Philippines is yet to recognize the concept of advance directives. Most Filipinos lack knowledge about advanced care planning and do not discuss this with their physicians. Even though they have yet to be widely introduced in the country, most hospitals still honor these documents.
As a family-oriented group of people, Filipinos often rely on their relatives for decisions. The choice to plan for end-of-life will not lie on a single person, but will be a collaborative decision. In the Philippine society, terminally ill patients often let their own families decide the treatments they will receive when they cannot decide for themselves.
Advance care planning, especially end-of-life matters, should be discussed while you are still in good health and of sound mind. Just as families and individuals prepare for marriage and childbirth, it cab be helpful to have a plan in case you sustain serious injury or contract a severe condition.
Types of Advance Directive Forms
Healthcare Power of Attorney
The healthcare power of attorney, also called the durable power of attorney or health care proxy, is an advance care directive that lets you choose another person to make healthcare decisions for you in the future. It will be carried out when you are incapacitated, in order to respect your wishes regarding your health.
In the form, you are called the “principal,” and the person you choose to make decisions is called your “agent.” As the principal, you may give your agent specific instructions about your care preferences. The agent would be required to honor your wishes and follow any detailed instructions you give regarding the care you want to be provided or withheld.
The agent you choose cannot be your healthcare provider. The person you select as your agent could be a significant other, friend, or relative, as long as you trust them to carry out your wishes. Be sure that they will advocate for you during end-of-life. It is also essential to consider if they are easily reachable by email, phone, or text. They must be within physical proximity when you are likely to receive care.
Living Will
A living will can also be an advance care directive you can use to declare your wishes to refuse, limit, or withhold life-sustaining treatment. It can only take effect if you have a terminal condition and are incapacitated or unable to communicate your preferences for care.
With a living will, your healthcare providers and family members will know what medical interventions you may or may not want to receive to sustain your life. This could include interventions like:
- Cardiopulmonary resuscitation (CPR)
- Ventilation (Respiratory machine)
- Artificially provided nutrition and hydration by tube or other medical means
- Dialysis
- Pain medications
Living wills are legal documents with specific requirements that need to be followed to be legally effective. It must be signed, witnessed, and certified. You must be at minimum 18 years or older and have a sound mind when you sign it in the presence of two (2) qualified witnesses or a notary public.
You can use a standard living will form, or you can write your own. Make clear and consistent choices on what you want to be done if your condition is terminal and incurable. A lawyer can guide you with your intentions and help you fill out the form correctly.
Do Not Resuscitate (DNR) Order
A Do Not Resuscitate (DNR) means that your healthcare providers will not perform cardiopulmonary resuscitation (CPR) should your heart stops or your breathing ceases. It can be part of your living will or any other type of advance directive. It can also be written in your medical chart by your physician.
As part of end-of-life planning for seriously ill patients, a DNR request and its likely outcomes should be discussed by the healthcare team with your relatives to prevent unnecessary and unwanted treatment at the end of life. A DNR does not equate to “Do Not Treat.” Depending on your condition, antibiotic therapy, blood transfusion, use of a ventilator, and other treatments that can prolong life will still be provided unless indicated in another advance directive.
In most cases, DNR is only effective in a hospital setting or when an individual is on hospice care. A claim for DNR should always be accompanied by a legal medical document for the reference of emergency personnel. Most first responders are usually required to initiate life support unless a valid DNR order is presented to them.
How to Create An Advance Directive
Acquire a standard form.
Here are a few ways to write an advance directive:
- Download a standard advance directive form.
- Write your wishes down by yourself.
- Ask your physician or your lawyer for a form.
Fill out the form.
The details you must include in your advance directive are:
- Your name and your contact information
- The quality of life that is unsatisfactory to you (e.g., chronic coma, persistent vegetative state, unable to communicate your needs, total or near dependence on others for care)
- Your preferences for care if you become incapacitated
- Life support options or life-sustaining treatments and interventions to be withheld or continued (e.g., CPR, food and water by tube or IV, antibiotic therapy, pain medications, ventilation)
- End of life wishes (e.g., hospice care, funeral arrangements, cremation, or burial preferences)
Appoint Healthcare Power of Attorney
It is highly encouraged to use a durable power of attorney for healthcare. This document is an accompaniment to your living will. Have multiple conversations with your chosen healthcare agent or proxy about your preferences. Make sure you are heard and understood. Complete the form by filling out your agent’s name and contact information.
If your primary healthcare agent cannot execute their duties, it is a good idea to appoint a successor or alternative agent.
Witness Acknowledgement
For your advance directive to be valid, it must be witnessed and signed by two persons. Witnesses cannot be your chosen agent or proxy, any of your healthcare providers, or a relative by blood or marriage. Your form must have the names and signatures of individuals who witnessed you signing your advance directive.
Notary Acknowledgement
In the Philippines, it is not required to have an advance care directive notarized for it to be valid. Still, a signature from a notary will make your advance directive legally binding in the event of conflicts. It is not difficult nor expensive to acquire a signature. Be sure to have signatures from all parties, including yours, before bringing it to a notary public.
Make a copy of your documents.
The original copy of your advance directive should be in a safe and accessible place in your home. However, it is an excellent idea to produce copies if ever your healthcare provider requires them for any reason.
The following people should also have a copy of your advance directives:
- Your healthcare agent/s
- Your physician
- Any trusted family member or friend who understands your end-of-life preferences
Reviewing Your Advance Directive
You can review or modify your advance directive anytime. It is advisable to update your advance directive if any circumstances impact your end-of-life care preferences. Once you have updated your form, be sure to have it signed, witnessed, and notarized again. Destroy every copy of your old directive and deliver the new documents to your physician, healthcare proxy, and anyone else with whom you shared your original directive.
Source:
McAdam, Jennifer L., et al. Attitudes of Critically Ill Filipino Patients and Their Families toward Advance Directives. American Journal of Critical Care, vol. 14, no. 1, Jan. 2005, pp. 17–25, doi:10.4037/ajcc2005.14.1.17.
