Advance care planning is an ongoing process of talking about your goals, values and wishes in terms of your health care. You are encouraged to discuss these topics with your family or friends, those who represent you and your health care team.

It helps to have these talks with your family and health care team early so that you may think through your options and identify what is most important to you about your future health care. In the event that your family or doctor needs to make choices when you are ill, they can do so with confidence that they are following your wishes.

How can I make my health care preferences known?

Whether you're a patient or caregiver, having conversations about future care should be part of your cancer treatment planning process at every stage. It should start at the time of diagnosis.

By preparing for your future, you can ensure your choices are given the utmost respect. Here are some steps for implementing the advance care planning process in your specific medical situation. This serves as a good starting point for patients and families.

Evaluate quality of life. Begin to think about what quality of life means to you. Ask yourself how you want to live. What is important for you to continue being able to do during your treatment or if you become seriously ill?

Have a conversation with your loved ones. Discuss your thoughts with the people who would be involved in making decisions for you if you aren't able to make them yourself. This will ensure that care choices support the quality of life you'd like.

Identify a loved one who can make decisions. Which person in your life do you trust to understand what quality of life means to you? Will this person be able to make these decisions if you aren't able to make them yourself?

Make sure this person is willing to make decisions for you if needed and that he or she knows what's important to you in your care choices. Don't assume anything.

Talk with your health care provider. Once you have defined your own terms for quality of life and identified someone to carry out your wishes, discuss this with your health care provider.  Your physician will be able to provide the medical perspective of your situation and your wishes.

Discussing this with your doctor informs him or her about what treatment options you would or wouldn't want down the road.

Complete the paperwork. Once you have made these decisions and had these conversations, complete the correct legal documents stating your wishes.

The Medical Power of Attorney and the Living Will are legally binding documents. When you can't make decisions for yourself, they state who will make decisions for you and what types of decisions will be made. If you complete these forms before your visit, please bring them with you to the hospital.

The Out-of-Hospital Do-Not-Resuscitate Order (OOHDNR) is also legally binding. It instructs paramedics, doctors and other health care professionals to refrain from performing cardiopulmonary resuscitation (CPR) when the heart and/or lungs stop working. After talking with their physicians, some people decide they do not want CPR either because it is unlikely to work or because it does not fit with their goals.

The OOHDNR only applies outside the hospital. If you are admitted to the hospital and do not wish to have CPR, let your doctor know. He or she can write an inpatient DNR order that applies throughout your stay. If you decide that either type of DNR order is right for you, it is important to remember that all efforts directed at your comfort will always continue, as will all other medical care that you and your doctor think is appropriate.


Adjust as your medical condition changes. Just because you make these important decisions at the beginning of your disease doesn't mean you can't change your mind later. Don’t hesitate to re-evaluate your treatment goals as needed.

To learn more about advance directives, the advance care planning process or to speak with someone about your end of life concerns, contact the Department of Social Work at patientrelations@novaglobalhealthcare.com , Or tell your nurse or doctor that you'd like to speak with a social work counselor.


Medical Power of Attorney

What You Need to Know

By completing the Medical Power of Attorney form, you can appoint someone you know and trust to be your agent. Your agent can make health care decisions for you if you are unable to make them for yourself. This form is an important legal document. Before signing it, be sure you understand the following facts and terms:

Agent

Anyone can be your agent except:

A person under 18 years of age, unless emancipated
Your health care provider
An employee of your health care provider, unless that employee is related to you
Your residential care provider (for example, nursing home or hospice)
An employee of your residential care provider, unless that employee is related to you

Tell the person you appoint that you want him/her to be your health care agent. Give him/her a signed copy of the Medical Power of Attorney form.

Authority of Agent

Your agent makes decisions only when you are not able to make them. Unless you state otherwise, he/she has the same authority to make health care decisions as you have now. Your agent may consent, refuse to consent, or withdraw consent to medical treatment. He/she may make decisions about continuing or stopping life support treatment.

A section on the Medical Power of Attorney form is called "Limitations on the Decision-Making Authority of My Agent Are As Follows." You can leave this section blank. However, your agent must follow any instructions you leave for him/her.

Examples of limitations you might choose include:

Provide comfortable, pain-free care
Do not keep me alive if I am going to remain in a coma
Use (or do not use) a feeding tube

Even after you have signed the Medical Power of Attorney form, you have the right to make health care decisions for yourself as long as you are able to do so. Treatment cannot be given to you or stopped over your objection. You have the right to take back the authority granted to your agent, at any time, either orally or in writing. To do so, tell your agent or your health care provider that you choose to take back the agent's power. You can do this regardless of your mental capacity or competence.

Witnesses

Your Medical Power of Attorney form is valid only when you sign it in the presence of at least two qualified witnesses. The following persons may not act as witnesses:

The person you have designated as your agent
A person related to you by blood or marriage
A person entitled to any part of your estate after your death under a will or codicil executed by you or by the operation of law
Your attending physician
An employee of your attending physician
An employee of a health care facility in which you are a patient if the employee is providing direct patient care to you or is an officer, director, partner, or business office employee of the health care facility or of any parent organization of the health care facility
A person who, at the same time this Power of Attorney is executed, has a claim against any part of your estate after your death.         If you have any questions, please contact our Social Work department at patientrelations@novaglobalhealthcare.com

Living Will

What You Need to Know

You may sign the living will form (Directive to Physicians and Family or Surrogates) if you are at least 18 years old, of sound mind and acting on your own free will. The directive instructs your doctor not to use life support to extend the natural process of dying. This directive will take effect only when you are in the terminal phase of an illness. Parents may complete a living will for children younger than 18 years of age.

If you sign a living will, talk about it with your doctor, and ask that a copy be made part of your medical record.

Oral Directives

You may tell your doctor your wishes if you are unable to sign a written directive.

Witnesses

Written or oral directives must be witnessed by two individuals. A notary is not necessary. The following persons may not act as witnesses:

The person you have designated as your agent
A person related to you by blood or marriage
A person entitled to any part of your estate after your death under a will or codicil executed by you or by the operation of law
Your attending physician
An employee of your attending physician
An employee of a health care facility in which you are a patient if the employee is providing direct patient care to you or is an officer, director, partner, or business office employee of the health care facility or of any parent organization of the health care facility
A person who, at the same time this power of attorney is executed, has a claim against any part of your estate after your death


ADVANCE CARE PLANNING